New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/10/2026 12:50:00 PM
Cost:
30
Service:
Frame + Lenses
prescribed by doctor:
old rx
Notes:
toric lenses
SPH
CYL
AX
ADD
OD
2
2.5
75
OS
1.75
2.25
80
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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