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    • Preventive Health Checkup Receipt

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    HealthyLife Preventive Care Center Your Wellness, Our Priority 221 Wellness Avenue Suite 304 San Diego, CA 92103 (858) 442-9988 www.healthylifeclinic.com contact@healthylifeclinic.com Clinic ID: HPC-789445

    Preventive Health Care Receipt Thank you for choosing HealthyLife Preventive Care Center.

    Customer Name:
    Rohan Mehta
    Doctor Name:
    Dr. Natalie Carter, MD
    Address Line 1:
    45 Garden Residency
    Department:
    Preventive Medicine
    Address Line 2:
    Block B
    Visit Reason:
    Annual Preventive Wellness Visit
    City, State ZIP:
    Ahmedabad, Gujarat 380015
    Symptoms Reported:
    None
    Country:
    India
    Visit Notes:
    Routine health evaluation, blood tests, vaccination administered.
    Email:
    rohan.m@example.com
    Phone:
    +91 98765 44321
    Patient ID:
    PAT-55621
    1
    General Wellness Examination
    $120.00
    1
    Blood Test — CBC & Lipid Profile
    $80.00
    1
    Vaccination — Flu Shot
    $45.00
    1
    Diet & Nutrition Consultation
    $65.00
    Subtotal$310.00
    Discount(10%)$31.00
    Tax(8.50%)$23.72
    Total
    $302.72
    Card Number**** **** **** 4922
    Card TypeDebit
    Card EntryChip
    Date/Time11/20/2019 11:09 AM
    Reference #62845289260246240685C
    StatusAPPROVED
    04/03/2026, 01:24:15 PM

    Receipt Number: PHC-2025-88429 QR Code Text: https://www.healthylifeclinic.com/receipt/PHC-2025-88429 For questions call (858) 442-9988 or email contact@healthylifeclinic.com Thank you for prioritizing your health!

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