Invoice No: #SM75692
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Date Of Services:
25 Feb 2022
237 Roanoke Road, North York,
Ontario, Canada
demo@email.com
+1-613-555-0141
Patient Name:
Micle Richard
Patient Birth Date:
32 Years Old - 22 July 1991
Insurence Billed:
WPS
Patient Name:
123456789
Services:
Dental Treatment
Due Date:
25 Feb 2022
Address:
4 Balmy Beach Road, Owen Sound, Ontario, Canada
Details | Price | Amount |
---|---|---|
Dental Treatment | $60 | $60 |
Bed Charge | $120 | $120 |
Consultant Surgeon Fee | $25 | $25 |
Medical Hospital Supply | $30 | $30 |
Nursing Service Charge | $20 | $20 |
Pay By Credit Card - 236***************** Amount: $ 113 - Due: $ 0 |
Tax: Total Amount: |
$13 $273 |
Note:
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