From:Insight Family Practice

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

To:Don Simons

226 S 800 W
Payson, UT 84651
US
Phone: (385) 214-1440
Invoice # 16398
Issued on August 4, 2026
Due on August 18, 2026
Balance Due $180.02

Task 1.0

Owed for 2/13/25 Appointment (co-insurance)

Rate

$28.55

Qty

1

Amount

$28.55

Task 2.0

Owed for 2/26/25 Appointment (co-insurance)

Rate

$15.58

Qty

1

Amount

$15.58

Task 3.0

Owed for 3/7/25 Appointment (co-insurance)

Rate

$20.56

Qty

1

Amount

$20.56

Task 4.0

Owed for 4/7/25 Appointment (co-insurance)

Rate

$115.33

Qty

1

Amount

$115.33

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 $180.02 Due in 2 Days 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

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