New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/27/2025 5:58:00 PM
Cost:: 15
Service:: Contact Lenses
prescribed by doctor:
Notes:: Clear 55 + Versace OD:-2.50 OD:-2.00

	SPH	CYL	AX	ADD
OD	-2	-0.5	180
OS	-1.5	-0.5	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS