New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/6/2025 5:38:00 PM
Cost:: 130
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Airlite + AR Lenses 1.67 for OS

	SPH	CYL	AX	ADD
OD	-3.25	-1.25	90
OS	-7.75	-1.25	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS