New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/22/2024 5:43:00 PM
Cost:
140
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Tom Ford Frame + Transition + AR W9
SPH
CYL
AX
ADD
OD
2
OS
2.25
Date of visit:
6/3/2024 4:09:00 PM
Cost:
0
Service:
Frame + Lenses
prescribed by doctor:
Old Rx
Notes:
Tom Ford Frame Broke Twice , we gave him OGA TR same degree AR+TRANS for free
SPH
CYL
AX
ADD
OD
2
OS
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
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