16440 – Owed for 2/13/25 Appointment

From:Insight Family Practice

8686 S 1300 E, Suite L102-104
Sandy, UT 84094
US

Phone: (801) 997-0368

insightfamilypractice@gmail.com

To:Ashley Miramontes

4134 West Teton Estates Drive
West Jordan, UT 84088
US

Phone: (385) 787-3406

Invoice # 16440

Issued on August 5, 2026

Due on August 19, 2026

Balance Due $40.00

Task 1.0

Owed for 2/13/25 Appointment (copay)

Rate

$40

Qty

Amount

$40

Total Owed

Subtotal
$40.00
Total
$40.00

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.

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