New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/26/2025 4:03:00 PM
Cost:
200
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Metal Gold + Infinity + AR + Transition Idol Montage
SPH
CYL
AX
ADD
OD
2.25
-0.5
90
2.5
OS
2.25
-0.5
85
2.5
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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