Invoice Dentist in Canada Toronto –Free Word Template Download with AI
123 Dental Avenue
Toronto, Ontario, Canada
M5V 2T6
Phone: (416) 555-1234
Email: [email protected]
Invoice #: INV-2023-00123
Date: October 15, 2023
Due Date: November 15, 2023
Billed To:
John Doe
456 Patient Street
Toronto, Ontario, Canada
M4B 1B3
Phone: (416) 555-5678
Email: [email protected]
Insurance Information:
Provider: Blue Cross
Policy Number: BC123456789
Group Number: GRP987654321
| Description | Code | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|
| Comprehensive Dental Examination | D0120 | 1 | $150.00 | $150.00 |
| Full Mouth X-Rays | D0330 | 1 | $200.00 | $200.00 |
| Professional Cleaning (Prophylaxis) | D1110 | 1 | $180.00 | $180.00 |
| Fluoride Treatment | D1206 | 1 | $50.00 | $50.00 |
| Composite Filling (Tooth #14) | D2391 | 1 | $250.00 | $250.00 |
| Root Canal Therapy (Tooth #19) | D3310 | 1 | $1,200.00 | $1,200.00 |
| Crown Preparation (Tooth #19) | D2740 | 1 | $1,500.00 | $1,500.00 |
| Temporary Crown (Tooth #19) | D2950 | 1 | $100.00 | $100.00 |
| Consultation for Orthodontic Treatment | D0601 | 1 | $100.00 | $100.00 |
| Whitening Treatment (In-Office) | D9910 | 1 | $400.00 | $400.00 |
Subtotal: $4,130.00
HST (13%): $536.90
Total Amount Due: $4,666.90
Payment Information:
Payment is due within 30 days of the invoice date. Please make checks payable to SmileBright Dental Clinic. For electronic payments, please contact our office for details.
Accepted Payment Methods: Cash, Credit Card (Visa, MasterCard, American Express), Debit Card, Interac e-Transfer
Notes:
This invoice is for dental services provided at SmileBright Dental Clinic in Toronto, Ontario, Canada. All prices are in Canadian Dollars (CAD). If you have any questions regarding this invoice or your treatment, please do not hesitate to contact us.
Thank you for choosing SmileBright Dental Clinic for your dental care needs. We are committed to providing you with the highest quality dental services in a comfortable and welcoming environment.
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