New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/19/2025 4:46:00 PM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	1.5	-0.75	165
OS	1.25

Date of visit:: 2/6/2026 5:04:00 PM
Cost:: 25
Service:: change lenses
prescribed by doctor:: LUNA
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2	-0.75	165
OS	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS