New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/25/2024 8:44:00 AM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD				1.25
OS				1.25

Date of visit:: 4/21/2025 11:50:00 AM
Cost:: 20
Service:: Change Lenses
prescribed by doctor:: dr. hassan bassam
Notes:: AR

	SPH	CYL	AX	ADD
OD	2
OS	2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS