New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/2/2026 11:40:00 AM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD		-0.25	180
OS		-0.25	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS