New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/28/2024 10:43:00 AM
Cost:: 10
Service:: Contact Lenses
prescribed by doctor:: Old RX
Notes:: Old Patient - Clear 55

	SPH	CYL	AX	ADD
OD	-3
OS	-3.25

Date of visit:: 5/17/2024 2:30:00 PM
Cost:: 11
Service:: Polyview
prescribed by doctor:: Old Rx
Notes:: (wasn't comfortable with Clear 55) and we added -0.25

	SPH	CYL	AX	ADD
OD	-3.25
OS	-3.5

Date of visit:: 3/26/2025 6:27:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Old Rx
Notes:: Polyview

	SPH	CYL	AX	ADD
OD	-3.75
OS	-3.75

Date of visit:: 5/5/2025 11:06:00 AM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: dr. moussa bassam
Notes:: poly view

	SPH	CYL	AX	ADD
OD	-3.75
OS	-4

Date of visit:: 7/10/2025 5:30:00 PM
Cost:: 12
Service:: Contact Lenses
prescribed by doctor:: Dr. Moussa Bassam
Notes:: poly view +solution

	SPH	CYL	AX	ADD
OD	-3.75
OS	-4.25

Date of visit:: 12/30/2025 4:31:00 PM
Cost:: 10
Service:: Contact Lenses
prescribed by doctor:: Luna
Notes:: Polyview

	SPH	CYL	AX	ADD
OD	-4
OS	-4.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS