New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/16/2024 4:51:00 PM
Cost:: 30
Service:: Change Lenses
prescribed by doctor:: OLD RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-2.25
OS	-1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS