New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/8/2025 2:19:00 PM
Cost:: 90
Service:: Change Lenses
prescribed by doctor:: old rx
Notes:: bifocal

	SPH	CYL	AX	ADD
OD	1.5	-2	94	2.25
OS	1.5	-2	90	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