New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
10/3/2025 4:19:00 PM
Cost:
Service:
Change Lenses
prescribed by doctor:
OLD RX
Notes:
TRANSITION W9
SPH
CYL
AX
ADD
OD
1
0.5
175
OS
2
1.5
115
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List