New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/9/2024 4:16:00 PM
Cost:: 25
Service:: Change Lenses
prescribed by doctor:
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-3	-0.75	180
OS		-1.5	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS