New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/3/2024 5:19:00 PM
Cost:: 35
Service:: Change lenses AR
prescribed by doctor:: Aya
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-1.25
OS	-2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS