New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2024 5:52:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Valentini Red for Near only

	SPH	CYL	AX	ADD
OD				0.75
OS				0.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS