New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/19/2025 1:58:00 PM
Cost:
90
Service:
Frame + Lenses + Change lenses
prescribed by doctor:
Dr. Nizar Salloukh
Notes:
AR Lenses , new frame for far , change lenses for old frame for near
SPH
CYL
AX
ADD
OD
2.5
0.75
10
2.25
OS
1.5
1.75
95
2.25
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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