New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/24/2024 12:56:00 PM
Cost:
Service:: 45
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.5	-1.5	20
OS	0.75	-1.5	180

Date of visit:: 9/19/2025 3:33:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Amichi Frame + AR + Transition

	SPH	CYL	AX	ADD
OD	-1.5	-1.5	15
OS	0.5	-1.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS