New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/16/2025 1:33:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Ghassan Albazzal
Notes:: AR Lenses compacted

	SPH	CYL	AX	ADD
OD	3	-1.5	175
OS	4	-2.75	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS