New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/17/2025 2:22:00 PM
Cost:: 150
Service:: Frame + Lenses
prescribed by doctor:: dr. brazil
Notes:: AR Lenses infinity +montage

	SPH	CYL	AX	ADD
OD	0.25	-0.75	105	1.5
OS	0.25	-0.5	105	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS