New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/8/2024 5:24:00 PM
Cost:: 140
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite + Prog Lenses AR MODERN + Transition FREEFORM

	SPH	CYL	AX	ADD
OD	1.5			2.25
OS	1.5			2.25

Date of visit:: 5/13/2026 1:56:00 PM
Cost:: 120
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: Progressive

	SPH	CYL	AX	ADD
OD	1.5			2.25
OS	1.5			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