New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2025 1:07:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Moussa Cheib
Notes:: AR Lenses high index

	SPH	CYL	AX	ADD
OD	-3.5	-1.25	170
OS	-4	-0.75	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS