New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 11/19/2025 4:53:00 PM
Cost:: 25
Service:: Contact Lenses
prescribed by doctor:
Notes:: Polyview TORIC

	SPH	CYL	AX	ADD
OD	5.75	-1.25	15
OS	3.5

Date of visit:: 11/24/2025 4:57:00 PM
Cost:: 30
Service:: Contact Lenses
prescribed by doctor:
Notes:: polyview TORIC

	SPH	CYL	AX	ADD
OD	4.5	1.25	105
OS	3.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS