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Shoebox · 2026

RIVERBEND PT

Physical therapy · Sample

07/12/202614:05

Therapy visit$124.00

Wellness add-on$62.00

TOTAL PAID$186.00

Card •• 4417Approved

||| || ||| | ||

Record · PT-0712

Medical

Physical therapy

Paid
$186.00
HSA-eligible
$124.00
  • Itemized receipt
  • Proof of payment
  • Prescription
$40.00 reimbursed$84.00 still available

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