New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/16/2024 2:48:00 PM
Cost:: 30
Service:: Freshlook or Airoptix BROWN
prescribed by doctor:: Old RX
Notes:

	SPH	CYL	AX	ADD
OD	-1.75
OS	-1.75

Date of visit:: 8/21/2024 3:18:00 PM
Cost:: 80
Service:: FRMELESS+LENSES AR
prescribed by doctor:: Dr.Hasan chahine
Notes:

	SPH	CYL	AX	ADD
OD	-1.75
OS	-1.75

Date of visit:: 1/21/2025 6:46:00 PM
Cost:: 50
Service:: Contact Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: BioMedics pack of 30 (1 DAY CL)

	SPH	CYL	AX	ADD
OD	-1.5
OS	-1.5

Date of visit:: 4/18/2025 5:21:00 PM
Cost:: 45
Service:: Biomedics 1 Day pack of 30
prescribed by doctor:: Old Rx
Notes:: Daily Lenses

	SPH	CYL	AX	ADD
OD	-1.5
OS	-1.5

Date of visit:: 6/27/2025 11:11:00 AM
Cost:: 45
Service:: Contact Lenses
prescribed by doctor:: Old RX
Notes:: biomedics one day

	SPH	CYL	AX	ADD
OD	-1.75
OS	-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