New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/17/2024 3:54:00 PM
Cost:: 80
Service:: Frame + Lenses+Lenses
prescribed by doctor:: Aya
Notes:: Zenni+AR (60$)+AR(20$)

	SPH	CYL	AX	ADD
OD				1.5
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