INVOICE - 310702 Date: Jul 9, 2026 at 12/03 PM

Foremed Clinic

420 Columbia St., New Westminster, BC V3L 1B1
Telephone: 604 522 2206

Fax: 604 522 7206

Billing To [Search] Patient ( 9128549738 )
Name: MARK THOMAS HOLAND Name: HOLAND , MARK THOMAS

Add H
Address: 311-318 Agnes st 31 1-318 Agnes st

City: New Westminster New Westminster , BC

é V3L0)3
Province: BC Gender: M

Postal: V3L0J3 Birth Date : 1978-09-04
Bill Details

Date Practitioner Payee Bet. Doctor ae sec oe
2026-03- Ademiluyi (68199),
09 Gbogboade

Line# Description Service Code QTY DX = Total amount

Codes GST
Written /Brief Certificate/Form
including school/work time off,
medical certificate for government
Receive employment insurance, SPARC-BC
310702 Parking Application, Handy Dart & A00060 1.0 780 52.90 2.65 55.55
Payment Handy Card Application + WCB &
ICBC Brief letter/note including
insurance note for
physiotherapy/massage therapy

2026-03-09

Payment(MASTERCARD)  43.18:13,9 —

Please Make Cheque Payable To: Subtotal: 52.30
F. Kara Holdings Lower Ltd. GST Total: 2.65
420 Columbia Street, New Westminster, BC, V3L 2X2 Total: 55.55
Telephone: 604-522-2206 Payments: 55.55
Fax: 604-522-7206 Refunds: 0.00
registration@secure.foremedclinic.com Balance: 0.00

Billing Notes:
reg dr\'s note - for collection c/o pm - see tickler - sol

Update Invoice || Edit Invoice |{ Print |{ Print With Notes }[ Cancel