New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/12/2025 3:32:00 PM
Cost:
150
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Rimless + polycarbonate + AR + IDOL MONATGE
SPH
CYL
AX
ADD
OD
1.5
-2.5
177
OS
1.75
-3.75
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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