New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/7/2024 12:15:00 PM
Cost:: 120
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Prada Metal + AR + Transition

	SPH	CYL	AX	ADD
OD	0	-2.75	20
OS	0	-1.75	160

Date of visit:: 3/17/2025 3:01:00 PM
Cost:: 0
Service:: Eye Exam
prescribed by doctor:: Luna
Notes:: 40$ without Trans - 60$ with Trans

	SPH	CYL	AX	ADD
OD	0	-2.75	20
OS	0.5	-2	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS