New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/1/2024 3:20:00 PM
Cost:: 340
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Bvlgari+ Olive People Transition AR

	SPH	CYL	AX	ADD
OD	2
OS	1.25

Date of visit:: 7/18/2024 4:58:00 PM
Cost:: 140
Service:: Gucci Cat Eye
prescribed by doctor:: OLD RX LUNA
Notes:: AR + TRANSITION (Monofocal)

	SPH	CYL	AX	ADD
OD	2
OS	1.25

Date of visit:: 7/18/2024 6:32:00 PM
Cost:: 53
Service:: CLEAR 55
prescribed by doctor:: Old RX
Notes:: + EYEDIA

	SPH	CYL	AX	ADD
OD	2
OS	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS