New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/26/2025 2:47:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Anti-Blue Transition Lenses
SPH
CYL
AX
ADD
OD
-1.25
-0.5
11
OS
-1.5
-0.5
170
Date of visit:
1/29/2026 12:54:00 PM
Cost:
50
Service:
change lenses
prescribed by doctor:
luna
Notes:
Antiblue transition
SPH
CYL
AX
ADD
OD
-1.5
-0.5
13
OS
-1.25
-1
175
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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