New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/12/2025 4:05:00 PM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.25	-1.75	1
OS	-0.25	-1.75	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS