New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/29/2025 12:17:00 PM
Cost:
80
Service:
Frame + Lenses
prescribed by doctor:
Optim Eyes
Notes:
The black glasses colored light yellow tint . The silver glasses colored blue tint baby blue
SPH
CYL
AX
ADD
OD
-1.25
-0.5
73
OS
-1.25
-0.5
65
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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