New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/28/2024 9:38:00 AM
Cost:
0
Service:
lenses
prescribed by doctor:
old glasses
Notes:
SPH
CYL
AX
ADD
OD
-1.25
-0.25
120
OS
-0.75
-0.5
30
Date of visit:
2/29/2024 4:38:00 PM
Cost:
14
Service:
Contact Lenses
prescribed by doctor:
FROM RX
Notes:
Took NEO Plus too
SPH
CYL
AX
ADD
OD
-1.5
OS
-1
Date of visit:
9/11/2024 4:24:00 PM
Cost:
11
Service:
Contact Lenses
prescribed by doctor:
Old RX
Notes:
SPH
CYL
AX
ADD
OD
-1.5
OS
-1
Date of visit:
9/11/2024 4:24:00 PM
Cost:
11
Service:
Contact Lenses
prescribed by doctor:
Old RX
Notes:
SPH
CYL
AX
ADD
OD
-1.5
OS
-1
Date of visit:
12/4/2024 5:51:00 PM
Cost:
20
Service:
Frame
prescribed by doctor:
Old RX
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
-1.25
-0.5
133
OS
-1.25
Date of visit:
3/19/2025 4:12:00 PM
Cost:
20
Service:
change lenses
prescribed by doctor:
old rx
Notes:
AR
SPH
CYL
AX
ADD
OD
-1.25
-0.5
133
OS
-1.25
Date of visit:
3/19/2025 4:12:00 PM
Cost:
15
Service:
Contact Lenses
prescribed by doctor:
old
Notes:
clear 55 + solution
SPH
CYL
AX
ADD
OD
-1.5
OS
-1
Date of visit:
8/2/2025 1:48:00 PM
Cost:
11
Service:
Contact Lenses
prescribed by doctor:
Old Rx
Notes:
Clear 55
SPH
CYL
AX
ADD
OD
-1.5
OS
-1.25
Date of visit:
11/11/2025 3:40:00 PM
Cost:
11
Service:
Clear 55
prescribed by doctor:
Old Rx
Notes:
Clear 55
SPH
CYL
AX
ADD
OD
-1.5
OS
-1.25
Date of visit:
8/2/2025 3:03:00 PM
Cost:
10
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR
SPH
CYL
AX
ADD
OD
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
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