From:Insight Family Practice

8686 S 1300 E, Suite L102-104
Sandy, UT 84094
US
Phone: (801) 997-0368
insightfamilypractice@gmail.com

To:Charles Burr

5044 S Boabab Dr
Salt Lake City, UT 84117
US
Phone: (801) 608-7336
Invoice # 4412
Issued on September 2, 2025
Due on October 2, 2025
Balance Due $350.40

Task 1.0

Owed for 01/09/2025 Office Visit: Patient Responsibility

Rate

$134.81

Qty

1

Amount

$134.81

Task 2.0

Owed for 2/6/25 appointment (not met deductible)

Rate

$79.01

Qty

1

Amount

$79.01

Task 3.0

Owed for 4/7/25 appointment (not met deductible)

Rate

$136.58

Qty

1

Amount

$136.58

Total Owed

Info & Notes

Thank you; we really appreciate your business.

Terms & Conditions

We do expect payment within 21 days, so please process this invoice within that time. There will be a 1.5% interest charge per month on late invoices.

Balance of $350.40 is Overdue Make a Payment

Make a Payment

Please enter your payment information to pay this invoice. A receipt for your records will be sent to you. Thank you very much!

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Invoice History

Status Update 368 days ago

Status changed: Draft to Pending.

Updated 368 days ago

Invoice updated by Insight Family Practice.

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