New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/5/2025 3:08:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Flex + AR Lenses

	SPH	CYL	AX	ADD
OD		-1	80
OS		-0.75	95

Date of visit:: 4/5/2025 5:41:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses for Near

	SPH	CYL	AX	ADD
OD	2.25	-1	80
OS	2.25	-0.75	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS