Preventive Health Checkup Receipt
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Preventive Health Checkup Center
Health Screening Services
125 Wellness Avenue
Austin, TX 78701
United States
Phone: (512) 555-2847
Health Screening Services
125 Wellness Avenue
Austin, TX 78701
United States
Phone: (512) 555-2847
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Your Health Matters
Thank You For Choosing Our Preventive Care Services
Thank You For Choosing Our Preventive Care Services
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Patient:John Doe
Receipt #:PHC-638214
Phone:(555) 123-4567
Staff:Emily Johnson
Patient ID:PHC-482917
Department:Preventive Care
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Date: 04/09/2026
Time: 15:46:26
Time: 15:46:26
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1General Health Consultation $45.00
1Complete Blood Count $30.00
1Blood Pressure Screening $15.00
1Blood Glucose Test $20.00
1Lipid Profile Test $35.00
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Subtotal$145.00
Tax $0.00
Total$145.00
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Payment MethodCredit Card (VISA)
Card Last 41234
Entry MethodChip Insert
Authorization Code583921
StatusAPPROVED
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1234567890
This is a sample receipt for demonstration purposes.
Please retain your receipt for your records.
Thank You For Choosing Our Preventive Health Services!
Please retain your receipt for your records.
Thank You For Choosing Our Preventive Health Services!
