New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/23/2025 1:50:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR

	SPH	CYL	AX	ADD
OD	-2.25
OS	-1.25	-0.5	175

Date of visit:: 12/3/2025 4:44:00 PM
Cost:: 10
Service:: Contact Lenses
prescribed by doctor:
Notes:: CLEAR 55

	SPH	CYL	AX	ADD
OD	-2.25
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