New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/13/2025 1:46:00 PM
Cost:
25
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
AR
SPH
CYL
AX
ADD
OD
0
-0.5
18
OS
0.5
-2.5
170
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List