New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
10/1/2025 3:16:00 PM
Cost:
90
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Oliver people + AR + Transition
SPH
CYL
AX
ADD
OD
-0.5
-0.25
175
OS
-0.5
-0.25
151
Date of visit:
12/27/2025 12:52:00 PM
Cost:
110
Service:
Frame + Lenses
prescribed by doctor:
OLD Rx
Notes:
OGA + AR + W9 Transition
SPH
CYL
AX
ADD
OD
-0.5
-0.25
175
OS
-0.5
-0.25
151
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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