New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/2/2025 2:42:00 PM
Cost:
70
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Metal Frame + AR Lenses
SPH
CYL
AX
ADD
OD
1.75
OS
1.75
Date of visit:
2/27/2026 1:02:00 PM
Cost:
90
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Sting Blue + AR LENSES for Near
SPH
CYL
AX
ADD
OD
2
OS
2.25
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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