New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/15/2024 3:20:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR 60mm + Airlite

	SPH	CYL	AX	ADD
OD	1.5
OS	3.75

Date of visit:: 9/20/2024 11:11:00 AM
Cost:: 15
Service:: change lenses
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2
OS	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS