New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/16/2025 4:34:00 PM
Cost:: 0
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75
OS	-0.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS