New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/8/2025 4:42:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Shoker
Notes:: Transition AR W9

	SPH	CYL	AX	ADD
OD	-4	-0.5	172
OS	-4	-0.5	166

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS