New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
10/27/2025 3:16:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Dr. Ali Hakim
Notes:
AR Lenses for both near and far
SPH
CYL
AX
ADD
OD
3
1
5
2.25
OS
4
1
140
2.25
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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