New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/16/2024 3:13:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD		-1.5	177
OS		-0.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS