New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/17/2024 5:34:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR LENSES

	SPH	CYL	AX	ADD
OD		-0.25	10
OS		-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