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 # 12311
Issued on April 9, 2026
Due on April 23, 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

1

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

1

Amount

$84.90

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.

Balance of $431.47 Due in 9 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

Viewed 3 days ago

Invoice viewed by 83.99.206.51 for the first time.