New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/27/2024 10:16:00 AM
Cost:
100
Service:
Progressive AR Modern
prescribed by doctor:
Aya
Notes:
Dior Frame
SPH
CYL
AX
ADD
OD
1.25
2.25
OS
1
2.25
Date of visit:
5/16/2025 3:41:00 PM
Cost:
100
Service:
Frame + Lenses
prescribed by doctor:
Dr. Ali Alhaj
Notes:
infinity progressive pro+montage
SPH
CYL
AX
ADD
OD
1.5
0.75
180
2
OS
1
0.75
160
2
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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