Invoice Dentist in Canada Montreal –Free Word Template Download with AI
Montreal Dental Care Centre
1234 Rue Sainte-Catherine Ouest, Montreal, Quebec, Canada H3G 1P5
Phone: (514) 555-1234 | Email: [email protected]
Quebec Dental Association Member #12345
Bill To:
Patient Name: John Doe
Address: 5678 Avenue du Parc, Montreal, Quebec, Canada H2V 4H7
Phone: (514) 555-6789
Email: [email protected]
Insurance Provider: Sun Life Financial
Policy Number: SL-987654321
Invoice Information:
Invoice Number: INV-2023-10-001
Date of Service: October 15, 2023
Invoice Date: October 16, 2023
Due Date: November 15, 2023
Payment Terms: Net 30 Days
Accepted Payment Methods: Cash, Credit Card, Debit, E-Transfer
This invoice details the professional dental services provided at our Montreal clinic in accordance with the standards set by the Quebec Dental Association and Canadian dental care regulations. All procedures were performed by licensed dentists and dental hygienists in compliance with Canadian health and safety protocols.
| Description of Service | ADA Code | Date | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|---|
| Comprehensive Dental Examination | D0150 | Oct 15, 2023 | 1 | $150.00 | $150.00 |
| Full Mouth X-Rays (Bitewing & Panoramic) | D0274 | Oct 15, 2023 | 1 | $200.00 | $200.00 |
| Professional Dental Cleaning (Prophylaxis) | D1110 | Oct 15, 2023 | 1 | $175.00 | $175.00 |
| Fluoride Treatment | D1206 | Oct 15, 2023 | 1 | $50.00 | $50.00 |
| Composite Filling (Tooth #19) | D2391 | Oct 15, 2023 | 1 | $250.00 | $250.00 |
| Oral Cancer Screening | D0120 | Oct 15, 2023 | 1 | $75.00 | $75.00 |
| Subtotal: | $900.00 |
| Quebec Sales Tax (QST) 9.975%: | $89.78 |
| Goods and Services Tax (GST) 5%: | $45.00 |
| Total Amount Due (CAD): | $1,034.78 |
Please remit payment within 30 days of the invoice date. Payments can be made via:
- Electronic Funds Transfer (E-Transfer): Send to [email protected] with your invoice number as the memo.
- Credit/Debit Card: Call our office at (514) 555-1234 to provide your card details securely.
- Cheque: Make payable to "Montreal Dental Care Centre" and mail to the address listed above.
If you have dental insurance, we can submit this invoice directly to your provider. Please ensure your policy information is up to date. For patients in Montreal and across Canada, we accept most major insurance plans including Sun Life, Manulife, Great-West Life, and Blue Cross. If you require a detailed explanation of benefits (EOB) or need to file a claim manually, please contact our billing department.
Important Notes:
- All prices are in Canadian Dollars (CAD).
- Taxes are calculated in accordance with Quebec and Canadian federal regulations.
- This invoice is valid for insurance claims and tax purposes.
- For any questions regarding this invoice, please contact our billing department at (514) 555-1234 or email [email protected].
- Montreal Dental Care Centre is committed to providing high-quality dental care in compliance with Canadian dental standards.
- Payment is due within 30 days. Late payments may incur a 1.5% monthly interest charge.
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