New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/25/2025 2:36:00 PM
Cost:: 100
Service:: Change Lenses
prescribed by doctor:: Dr. Hassan Salam
Notes:: AR Compact 1.67

	SPH	CYL	AX	ADD
OD	-6.5	-1.25	5
OS	-6.25	-1.5	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS