New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/18/2024 2:11:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite + AR Lenses + Compact

	SPH	CYL	AX	ADD
OD	4.5	-0.75	150
OS	4	-0.75	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS