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

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS