ideal vision CENTER CERTIFICATION Date: PCUST 22, 202) To whom it may concern: Thisis to certify that__7- RVLv7 mney Kw underwent routine eye exam on F2 aero (symptoms) 20 vii an ap Pe Examination done:__ “207g susurve Pacey Diagnosis: "40777 Recommendatio' Nea nan _raesilppier RfeGCbe SPECTACLE Rx UVA ‘SPHERE CYLINDER | AXIS ADD PD BCVA oD | a7 _| (Pak Loo os | Yo | -1.25 BA Dy ‘CONTACT LENS Rx I ‘SPHERE CYLINDER AXIS BC DIA [ ‘ADD /Tint 00 | { { [es] \ \ \ jo Buse eth : 6, MO oo Dio har Amount: fe This certification is issued upon the request of the patient for whatever legal purpose this may serve. Respectfully yours, pies Optometrist Ophthalmologist SIGNATURE OVER PRINTED NAME License No. PTR No. Scanned with CamScanner