New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/27/2025 4:45:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	0.25	-1.25	180
OS	0.5	-1.25	20

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS