New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/21/2024 2:04:00 PM
Cost:: 20
Service:: Contact Lenses Toric "Saad"
prescribed by doctor:: Old RX
Notes:: 1 Pair of Lenses

	SPH	CYL	AX	ADD
OD	-2	-2.5	10
OS	-1.75	-1.75	175

Date of visit:: 6/25/2024 4:17:00 PM
Cost:: 20
Service:: Toric Polyview SAAD
prescribed by doctor:: Old Rx
Notes:

	SPH	CYL	AX	ADD
OD	-2	-2.5	10
OS	-1.75	-1.75	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS