New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/30/2024 4:23:00 PM
Cost:: 110
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Zorkot
Notes:: Clip On + Compact

	SPH	CYL	AX	ADD
OD	1	0.75	95
OS	0.5	1	70

Date of visit:: 5/30/2024 4:24:00 PM
Cost:: 65
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Zorkot
Notes:: Frame + Lenses for Near

	SPH	CYL	AX	ADD
OD	1.75	0.75	95
OS	1.25	1	70

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS