New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/22/2024 5:34:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1	-3	20
OS	-1.5	-3.25	175

Date of visit:: 12/25/2024 4:14:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-1	-3.5	20
OS	-1.5	-3.75	175

Date of visit:: 3/27/2025 3:26:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: Airlite + AR Lenses compact

	SPH	CYL	AX	ADD
OD	-1	-3.5	20
OS	-1.5	-4	175

Date of visit:: 3/27/2025 3:26:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: Airlite + AR Lenses compact

	SPH	CYL	AX	ADD
OD	-1	-3.5	20
OS	-1.5	-4	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS