New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/18/2025 6:21:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	-0.25	-1.25	98
OS		-1.75	78

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS