From:Insight Family Practice

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

To:Robyn Furtak

531 N 600 E
Spanish Fork, UT 84660
US
Phone: (702) 472-5603
Invoice # 16740
Issued on August 7, 2026
Due on August 21, 2026
Balance Due $40.71

Task 1.0

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

Rate

$10.71

Qty

1

Amount

$10.71

Task 2.0

Owed for 5/5/25 Appointment (copay)

Rate

$30

Qty

1

Amount

$30

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 $40.71 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

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