New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/30/2024 5:39:00 PM
Cost:: 160
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: AR + Transition + FREEFORM

	SPH	CYL	AX	ADD
OD	0			1.75
OS	0			1.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS