New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/26/2025 3:31:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Sabrina Rammal
Notes:: Airlite RED + AR LENSES

	SPH	CYL	AX	ADD
OD	1.25	-0.25	100
OS	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS