New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2024 5:39:00 PM
Cost:: 15
Service:: Clear 55 contact lenses
prescribed by doctor:: Old Rx
Notes:: With NEO PLUS

	SPH	CYL	AX	ADD
OD	-8
OS	-8

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS