New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/27/2024 6:00:00 PM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: W9 Transition AR + Flex Metal

	SPH	CYL	AX	ADD
OD	-0.5
OS	-0.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS