Doctor Note

Present clear recommendations from the doctor.

EN ES

created by Marcy O

Patient & Prescription

Patient full name

OD (Right)

SPH CYL AXIS

ADD

OS (Left)

SPH CYL AXIS

ADD

Lifestyle (optional)

Night driving glare Heavy digital/device use Spends time outdoors Light sensitive Works from home/office Prefers thin/light lenses

6060

6060 Optical

Doctor’s Note

Dr. Amel Youssef, OD

Patient:

Dr. Amel Youssef, OD