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birthdate: september,2, 1999
have a account: yes, recently signed up
if so, please list it: yellowroadstoneyes-11223344@wmailnotnow
have records: no, never want them
if so, please list it: none, dont want it
bills unpaid: yes
if so, please list: x ray and blood drawn
have you been here before: yes
what bills would you like to pay today: just blood
how many: twice to pay
will you please list the price if you know: $16.00 each
main doctor: doc. Layla Row
last test: x ray
any allergies: apples
any notes to add: none
THANK YOU AND HAVE A WONDERFUL OF DAY!!!!!!
questions: none
comments: none
window: 5
service: paying bills
provider: Ruby Hudson
insurance: r and r u
debit/credit/cash/check: credit
email: mayleerowuknow
Phone: 555 777 888
account signing: yellowroadstoneyes-11223344@wmailnotnow
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