New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/24/2025 4:39:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:
Notes:: blue cut

	SPH	CYL	AX	ADD
OD	-4	-0.5	170
OS	-2.25	-0.75	25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS