New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/31/2024 2:38:00 PM
Cost:: 15
Service:: Change Lenses
prescribed by doctor:: OLD degrees
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	0
OS	0

Date of visit:: 3/21/2024 1:47:00 PM
Cost:: 40
Service:: Contact Lenses Toric "Saad"
prescribed by doctor:: Old RX
Notes:: 2 Pairs of Lenses

	SPH	CYL	AX	ADD
OD	-2.5	-0.75	160
OS	-2.5	-1.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS