EFTA Document EFTA02040128

STATEMENT Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 Mr. Jeff J Epstein 9 East 71st Street New York NY 10021 Telephone: (212) 688-1090 II pawN try credd card. order the amount you se wig In Ow remittance box and H HA baba Mastercard We Amex Cads Exp Ogle Synalure SIO Cato Date Account 7/28/2016 11394 Remittance IMPORTANT • PLEASE DETACH UPPER PORTION AND RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Previous Balance 0.00 7/21/2016 Wandi Comprehensive Oral eval 75.00 75.00 7/21/2016 Wandi Adult Scale & Prophy 180.00 255.00 7/21/2016 Wandi Panoramic Radiographic Image 225.00 480.00 ilialfainiknewiti• rParg.elaiThWt ragid&rown a Ittta—e 2 4911.0111,4- eate.4.• 2,880.00 Account Total 2,880.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete and return the top part of this statement, or call the office at 212.688-1090. Current 30 Days 60 Days 90 Days 120+ Days 2,880.00 0.00 0.00 0.00 0.00 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA_R1_00561197 EFTA02040128 From. Lesley Gra Subject: Dr. Magni for Wanda Date: July 20, 2016 at 2:10 PM To: Bella Klein Wandi Zhu will go see Dr. Magnani tomorrow (Thur. July 21st) for a cleaning, check up and Invisiline consultation. EFTA_R1_00561198 EFTA02040129