Invoice Dentist in Australia Brisbane –Free Word Template Download with AI
Level 3, 123 Queen Street
Brisbane City, QLD 4000
Australia
Phone: (07) 3000 1234
Email: [email protected]
ABN: 12 345 678 901
Provider Number: 1234567890
| Invoice Number: | INV-2024-0892 |
| Date Issued: | 15 March 2024 |
| Due Date: | 15 April 2024 |
| Service Date: | 10 March 2024 |
BILL TO:
Mr. James Anderson
45 River Terrace
New Farm, QLD 4005
Australia
Phone: 0412 345 678
Email: [email protected]
PATIENT DETAILS:
Patient Name: Mr. James Anderson
Date of Birth: 12/05/1985
Medicare Number: XXXXXXXXXX
Private Health Fund: Bupa Private Health
Policy Number: BUP-987654321
Member Number: MEM-123456
DENTAL SERVICES PROVIDEDThe following dental services were provided at our Brisbane clinic in accordance with the Australian Dental Association (ADA) item numbers and fee guidelines. All treatments were performed by qualified dental professionals registered with the Dental Board of Australia.
| ADA Item No. | Description of Dental Service | Qty | Unit Price (AUD) | GST | Total (AUD) |
|---|---|---|---|---|---|
| 301 | Comprehensive Dental Examination and Assessment including oral cancer screening | 1 | $185.00 | $16.82 | $201.82 |
| 302 | Full Mouth Radiographic Examination (OPG and Bitewings) | 1 | $145.00 | $13.18 | $158.18 |
| 401 | Professional Dental Cleaning (Scale and Polish) - Upper Arch | 1 | $165.00 | $15.00 | $180.00 |
| 401 | Professional Dental Cleaning (Scale and Polish) - Lower Arch | 1 | $165.00 | $15.00 | $180.00 |
| 501 | Composite Resin Filling - Single Surface (Tooth #14) | 1 | $220.00 | $20.00 | $240.00 |
| 502 | Composite Resin Filling - Two Surfaces (Tooth #30) | 1 | $275.00 | $25.00 | $300.00 |
| 601 | Local Anaesthesia Administration | 1 | $35.00 | $3.18 | $38.18 |
| 701 | Fluoride Treatment Application | 1 | $45.00 | $4.09 | $49.09 |
| Subtotal (Excluding GST): | $1,235.00 |
| GST (10%): | $112.27 |
| Total Amount Due: | $1,347.27 AUD |
| Medicare Rebate (Estimated): | -$0.00 |
| Private Health Rebate (Estimated): | -$450.00 |
| Patient Out-of-Pocket: | $897.27 AUD |
PAYMENT BY BANK TRANSFER
Bank: Commonwealth Bank of Australia
BSB: 062-000
Account Name: Brisbane Central Dental Clinic Pty Ltd
Account Number: 12345678
Reference: INV-2024-0892
PAYMENT OPTIONS
We accept all major credit cards (Visa, Mastercard, Amex) and EFTPOS.
Payment plans available through Zip Money and Afterpay for eligible treatments.
Please contact our billing department for payment arrangements.
IMPORTANT NOTES AND TERMS:
1. GST Compliance: This invoice is issued in accordance with Australian Taxation Office (ATO) requirements. GST is applicable to all dental services provided as per Australian tax law.
2. Medicare and Private Health: This dental invoice may be eligible for rebates through Medicare (for eligible patients) and private health insurance funds. Please submit this invoice to your health fund for claim processing. Our clinic offers direct claiming for selected funds.
3. Payment Terms: Payment is due within 30 days of the invoice date. Late payments may incur interest charges at the rate prescribed by Australian law. Please contact us immediately if you experience difficulty meeting the payment deadline.
4. ADA Item Numbers: All services are coded according to the Australian Dental Association (ADA) Schedule of Dental Benefits and Fees, which is the standard reference for dental billing across Australia, including Queensland and Brisbane.
5. Privacy: Your personal and health information is handled in accordance with the Australian Privacy Principles (APP) and the Privacy Act 1988 (Cth).
6. Disputes: If you have any questions or disputes regarding this invoice, please contact our billing team within 14 days. We are committed to resolving any concerns promptly and professionally.
7. Brisbane Clinic Location: All services were rendered at our Brisbane City clinic located at Level 3, 123 Queen Street, Brisbane City, QLD 4000, Australia.
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