New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/1/2025 5:49:00 PM
Cost:: 100
Service:: 2 Frame + 2 Lenses
prescribed by doctor:: Nancy
Notes:: olive optical frame, AR Lenses for Both

	SPH	CYL	AX	ADD
OD	0.75			2
OS	1.25			2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS