New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/30/2024 1:21:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: Metal + Progressive + AR Freeform

	SPH	CYL	AX	ADD
OD	1			2.25
OS	1			2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS