contact.carestreamdental.com.au
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203.206.167.66
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Submitted URL: http://tiny.cc/yjohuz?p=stm&h=NDUwNjk3LjI
Effective URL: https://contact.carestreamdental.com.au/theorthodontist/view.php?p=stm&h=NDUwNjk3LjI
Submission: On May 02 via manual from AU — Scanned from AU
Effective URL: https://contact.carestreamdental.com.au/theorthodontist/view.php?p=stm&h=NDUwNjk3LjI
Submission: On May 02 via manual from AU — Scanned from AU
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* View * Save PDF * Web Print #44186 Dr Con Laparidis - ABN 53 544 139 055 Specialist Orthodontist 50 Hutt Street Provider Information PROVIDER: Con Laparidis - 0624662L Ms. Tammy Meekins & Mark Lawson 12B Wattle Terrace PLYMPTON PARK SA 5038 Statement Date: 02/05/2023 Amount Due: 39.00 Account Balance Due This Month Over 30 Days Over 60 Days Over 90 Days 6,539.00 39.00 0.00 0.00 0.00 ACCOUNT ACTIVITY SINCE LAST STATEMENT Date Patient Description Amount Patient Doctor 01/02/2023 Kole Complete course of orthodontic treatment Item 881 - Contract 8,250.00 8,250.00 Con Laparidis 01/02/2023 Kole Complete course of orthodontic treatment Item 881 - Initial Fee (Contract) 1,000.00 0.00 Con Laparidis 01/02/2023 Kole Cash : deposit (mum) -500.00 -500.00 Con Laparidis 01/02/2023 Kole Cash : deposit (dad) -500.00 -500.00 Con Laparidis 01/02/2023 Kole Study Models (Scanned) x 2 Item 071 x 2 95.00 95.00 Con Laparidis 01/02/2023 Kole Photographic Records - Intraoral Item 072 25.00 25.00 Con Laparidis 01/02/2023 Kole Photographic Records - Extraoral Item 073 25.00 25.00 Con Laparidis 23/02/2023 Kole Credit Card : -125.00 -125.00 Con Laparidis 01/03/2023 Kole Complete course of orthodontic treatment Item 881 - Contract Charge 250.00 0.00 Con Laparidis 15/03/2023 Kole Cash : (Dad) -250.00 -250.00 Con Laparidis 01/04/2023 Kole Complete course of orthodontic treatment Item 881 - Contract Charge 250.00 0.00 Con Laparidis 14/04/2023 Kole Credit Card : Item 881 (phone payment - Mum) -125.00 -125.00 Con Laparidis 01/05/2023 Kole Complete course of orthodontic treatment Item 881 - Contract Charge 250.00 0.00 Con Laparidis 02/05/2023 Kole Cash : (Dad) -500.00 -500.00 Con Laparidis Thank you for your prompt payment! Detach lower portion of statement and return with payment -------------------------------------------------------------------------------- Ms. Tammy Meekins & Mark Lawson 12B Wattle Terrace PLYMPTON PARK SA 5038 Patient Number Amount Due Kole18431439.00 Statement Date: 02/05/2023 Amount Paid: INTERNET PAYMENT: BSB:085458 A/C:829638989