New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/29/2025 2:57:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Dacchi Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	2.5	-3	175
OS	2.75	-3	170

Date of visit:: 9/29/2025 2:58:00 PM
Cost:: 30
Service:: Toric Contact Lenses
prescribed by doctor:: Same as RX
Notes:: TORIC SAAD

	SPH	CYL	AX	ADD
OD	2.5	-3	175
OS	2.75	-3	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS