New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/23/2026 11:57:00 AM
Cost:: 250
Service:: Frame + Lenses
prescribed by doctor:: luna
Notes:: polycarbonate idol montage AR ma3 lam3a

	SPH	CYL	AX	ADD
OD	-3	-2.25	180
OS	-2	-2.75	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS