New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/31/2026 1:55:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	1	-2.25	180
OS	0.75	-2.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS