From:Insight Family Practice

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

To:Amanda Derose-Oliver

799 E larkspur dr
Sandy, UT 84094
US
Phone: (801) 372-6639
Invoice # 5726
Issued on September 28, 2025
Due on October 27, 2025
Balance Due $72.22

Task 1.0

01/23/2025 Office Visit: Patient Responsibility

Rate

$72.22

Qty

1

Amount

$72.22

Total Voided

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 $72.22 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 303 days ago

Status changed: Draft to Pending.

Updated 303 days ago

Invoice updated by Insight Family Practice.

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Updated 161 days ago

Invoice updated by info@utahwebdesignpros.com.

Updated 161 days ago

Invoice updated by info@utahwebdesignpros.com.

Updated 161 days ago

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Updated 21 days ago

Invoice updated by info@utahwebdesignpros.com.

Status Update 20 days ago

Status changed: Pending to Written Off.