New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/6/2026 4:56:00 PM
Cost:
115
Service:
Frame + Lenses, change lenses
prescribed by doctor:
Dr. Ali Alhaj
Notes:
AR Lenses for FAR, AR COMPACTED FOR NEAR
SPH
CYL
AX
ADD
OD
1.5
1
90
1.25
OS
0.75
1
65
1.25
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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