New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/15/2025 1:15:00 PM
Cost:: 120
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Antiblue transition W9

	SPH	CYL	AX	ADD
OD	0	-3	175
OS	-0.25	-2.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS