New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/2/2026 3:31:00 PM
Cost:
95
Service:
Change Lenses +Frame +lenses
prescribed by doctor:
dr. prescription
Notes:
both AR FOR NEAR
SPH
CYL
AX
ADD
OD
2
OS
1.75
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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