New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/10/2025 12:03:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.25
OS	-1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS