New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/20/2025 4:53:00 PM
Cost:: 20
Service:: Change Lenses
prescribed by doctor:: Luna
Notes:: AR LENSES FOR DISTANCE ONLY (he will come back to do the near ones)

	SPH	CYL	AX	ADD
OD	0.75			1.5
OS	0.75			1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS