New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/3/2024 4:26:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Dr. Fouad Khreiss
Notes:: green coated anti blue for near only

	SPH	CYL	AX	ADD
OD				0.75
OS				0.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS