New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/12/2025 4:43:00 PM
Cost:: 150
Service:: Frame + Lenses + Change lenses
prescribed by doctor:: Nancy
Notes:: ANTIBLUE GREEN COATED

	SPH	CYL	AX	ADD
OD	-2.5	-0.25	157
OS	-0.5	-0.25	13

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS