From:Insight Family Practice

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

To:Jose Mata

285 E 1450 N
#108
Bountiful, UT 84010
US
Phone: (801) 919-4804
Invoice # 5685
Issued on September 28, 2025
Due on October 27, 2025
Balance Due $21.03

Task 1.0

01/10/2025 Office Visit: Patient Responsibility

Rate

$21.03

Qty

1

Amount

$21.03

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 $21.03 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 198 days ago

Status changed: Draft to Pending.

Updated 198 days ago

Invoice updated by Insight Family Practice.

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