New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/23/2024 2:05:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Dr.Fouad Khriess
Notes:: Progressive Freeform Modern AR+ Frame

	SPH	CYL	AX	ADD
OD	-0.75	-4	180	1.25
OS	-0.25	-4	180	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS