New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/4/2025 5:22:00 PM
Cost:
90
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
Airlite + AR Lenses
SPH
CYL
AX
ADD
OD
-0.75
-0.5
130
OS
-0.75
-0.5
15
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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