New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/30/2024 5:21:00 PM
Cost:: 35
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses + Metal Frame

	SPH	CYL	AX	ADD
OD	-0.25	-0.25	80
OS	-0.25	-0.25	30

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS