New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/21/2026 5:52:00 PM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
Old RX+nancy
Notes:
AR Transition
SPH
CYL
AX
ADD
OD
1.25
-2.5
3
OS
2.75
-2.5
175
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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