"First Name" field is required.

"Last Name" field is required.

"Street Address" field is required.

"City" field is required.

"ZIP Code" field is required.

"State" field is required.

"Country" field is required.

"Cardholder Name" field is required.

"Card Number" field is required.

"Expiration Date" field is required.

"Security Code" field is required.

E00003 The element 'creditCard' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd' has invalid child element 'expirationDate' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd'. List of possible elements expected: 'cardNumber' in namespace 'AnetApi/xml/v1/schema/AnetApiSchema.xsd'.

Payment Pending

11297

From:Insight Family Practice

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

Phone: (801) 997-0368

insightfamilypractice@gmail.com

To:Nicole Sanders Whitesel

629 E 700 N
Springville, UT 84663
US

Phone: (801) 888-0885

Invoice # 11297

Issued on February 9, 2026

Due on March 2, 2026

Balance Due $431.47

Task 1.0

Due for Ketamine Treatment Date of Service: 4/18/2024 – Patient did not have active Aetna insurance coverage as primary

Rate

$346.57

Qty

Amount

$346.57

Task 2.0

Due for Ketamine Treatment Date of Service: 6/26/2024 – Patient did not have active Aetna insurance coverage as primary

Rate

$84.90

Qty

Amount

$84.90

Total Owed

Subtotal
$431.47
Total
$431.47

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.

Balance of $431.47 is Overdue Make a Payment

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Please enter your payment information to pay this invoice. A receipt for your records will be sent to you. Thank you very much!

Credit Card

First Name *

Last Name *

Street Address *

Street Address 2

City *

ZIP Code *

State *

Country *

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

First Name *

Last Name *

Street Address *

Street Address 2

City *

ZIP Code *

State *

Country *

Cardholder Name *

Card Number *

Expiration Date *

Security Code *

Invoice History

Status Update 66 days ago

Status changed: Draft to Pending.

Status Update 66 days ago

Status changed: Draft to Pending.

Viewed 61 days ago

Invoice viewed by 202.76.139.162 for the first time.

Viewed 59 days ago

Invoice viewed by 113.181.56.178 for the first time.

Updated 59 days ago

Invoice updated by info@utahwebdesignpros.com.

Updated 59 days ago

Invoice updated by info@utahwebdesignpros.com.

Updated 59 days ago

Invoice updated by info@utahwebdesignpros.com.

Viewed 58 days ago

Invoice viewed by 129.222.147.69 for the first time.

Viewed 57 days ago

Invoice viewed by 123.31.96.44 for the first time.

Viewed 54 days ago

Invoice viewed by 83.99.206.228 for the first time.

Viewed 39 days ago

Invoice viewed by 83.99.206.1 for the first time.

Viewed 21 days ago

Invoice viewed by 103.251.125.59 for the first time.

From:Insight Family Practice

To:Nicole Sanders Whitesel

Task 1.0

Rate

Qty

Amount

Task 2.0

Rate

Qty

Amount

Total Owed

Subtotal

Total

Info & Notes

Terms & Conditions

Make a Payment

Invoice History