New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/17/2024 6:09:00 PM
Cost:
80
Service:
Frame airlite + AR
prescribed by doctor:
Dr. Jamal Bleik
Notes:
Synchrony By Zeiss
SPH
CYL
AX
ADD
OD
2.5
0.75
90
OS
1.75
1.5
90
Date of visit:
3/18/2024 6:11:00 PM
Cost:
80
Service:
Change Lenses
prescribed by doctor:
Dr. Jamal Bleik
Notes:
Synchrony by Zeiss
SPH
CYL
AX
ADD
OD
2.5
0.75
90
OS
1.75
1.5
90
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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