New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/16/2024 3:08:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR Lenses compact

	SPH	CYL	AX	ADD
OD	-5
OS	-5

Date of visit:: 6/5/2025 6:40:00 PM
Cost:: 11
Service:: Contact Lenses
prescribed by doctor:: Old Rx
Notes:: Clear 55

	SPH	CYL	AX	ADD
OD	-5
OS	-5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS