New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/5/2025 12:03:00 PM
Cost:: 180
Service:: 2Frame + Lenses
prescribed by doctor:: dr. Alexandre Assi
Notes:: AR ,2FRAMES

	SPH	CYL	AX	ADD
OD	-1.25
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