New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/8/2025 4:47:00 PM
Cost:
110
Service:
2 Frame + 2 Lenses
prescribed by doctor:
Nancy
Notes:
AR Lenses ONE for Dist ONE for Near
SPH
CYL
AX
ADD
OD
-2.75
-1.5
120
2.25
OS
1.75
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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