New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/4/2026 2:05:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: dr. Ali Alhaj
Notes:: Antiblue

	SPH	CYL	AX	ADD
OD	-0.25	-1.25	100
OS	-0.5	-1	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS