New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/25/2024 6:00:00 PM
Cost:: 100
Service:: 2 Frame +2 Lenses
prescribed by doctor:: Dr. Haitham Satti
Notes:: AR Lenses for both 50+50

	SPH	CYL	AX	ADD
OD	0.75	-1.5	90	2.5
OS	1.25	-2.25	105	2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS