New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
11/29/2025 11:58:00 AM
Cost:
65
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Airlite + AR Lenses
SPH
CYL
AX
ADD
OD
-0.5
-0.25
50
OS
-0.5
-0.25
70
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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