New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/14/2025 12:24:00 PM
Cost:: 35
Service:: Change Lenses
prescribed by doctor:: Dr. George Cherfan
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-6.25
OS	-6.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS