Invoice #1041
Nov 4, 2026, 5:35 PM
Summary
Paid
| Item | Qty | Price | Amount |
|---|---|---|---|
| New patient exam, x-rays and cleaning | 1 | $115.00 | $115.00 |
Total$115.00
Paid$115.00
Patient
Name
Email
malik.coleman@example.com
Phone
(630) 555-0134
Payment
Status
Paid
Due
Nov 18, 2026