New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/5/2025 5:40:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Carrera Frame + AR Lenses for NEAR

	SPH	CYL	AX	ADD
OD	1.5
OS	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS