New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/3/2025 12:12:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Dacchi , AR transition

	SPH	CYL	AX	ADD
OD	-1.75
OS	-1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS