New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/5/2025 11:35:00 AM
Cost:
170
Service:
Frame + Lenses(2)
prescribed by doctor:
0ld rx
Notes:
2 tommy helifiger sunglasses with presciption
SPH
CYL
AX
ADD
OD
-0.25
-0.25
130
OS
-1.5
175
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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