New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/27/2024 4:17:00 PM
Cost:
140
Service:
New frame nylor + Transition lenses + New frame without lenses
prescribed by doctor:
Old Rx
Notes:
New = 110$ + Frame ONLY = 30$
SPH
CYL
AX
ADD
OD
-1.5
-0.5
70
OS
-1.75
-0.5
60
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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