From:Insight Family Practice

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

To:Ian Bell

14038 S Pine Mesa Dr.
Draper, UT 84020
US
Phone: (801) 888-1018
Invoice # 5689
Issued on September 28, 2025
Due on October 27, 2025
Balance Due $50.00

Task 1.0

Owed for 1/10/25 Appointment (patient responsibility)

Rate

$25

Qty

1

Amount

$25

Task 2.0

Owed for 2/7/25 Appointment (copay)

Rate

$15

Qty

1

Amount

$15

Task 3.0

Owed for 3/7/25 Appointment (copay)

Rate

$10

Qty

1

Amount

$10

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 $50.00 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 322 days ago

Status changed: Draft to Pending.

Updated 322 days ago

Invoice updated by Insight Family Practice.

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