Invoice #1026
Oct 20, 2026, 9:00 AM
Summary
Paid
| Item | Qty | Price | Amount |
|---|---|---|---|
| New patient exam, x-rays and cleaning | 1 | $105.00 | $105.00 |
Total$105.00
Paid$105.00
Patient
Name
Email
james.ibrahim@example.com
Phone
(630) 555-0146
Payment
Status
Paid
Due
Nov 3, 2026