New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/9/2025 1:16:00 PM
Cost:: 25
Service:: Change Lenses
prescribed by doctor:: Dr. Ghassan Khoury
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75	1.25	180
OS	-0.75	1.75	20

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS