New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/24/2024 7:37:00 PM
Cost:: 50
Service:: Metal Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-2
OS	-1.75

Date of visit:: 6/14/2025 6:44:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR + Transition

	SPH	CYL	AX	ADD
OD	-2.5
OS	-2	-0.5	70

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS