New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/26/2024 12:51:00 PM
Cost:: 50
Service:: Frame + Lenses + Change lenses
prescribed by doctor:: Aya
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1			2
OS	-1			2

Date of visit:: 7/23/2024 7:14:00 PM
Cost:: 30
Service:: change lenses
prescribed by doctor:: Dr. Mohammad Assaf
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.5
OS	-1	-0.25	135

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS