New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/5/2025 5:20:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Sketchers Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	-1	-0.5	71
OS	-1.25	-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS