Invoice Dentist in Canada Vancouver –Free Word Template Download with AI
1234 West Georgia Street, Suite 500
Vancouver, BC V6E 4R2, Canada
Phone: (604) 555-0199
Email: [email protected]
Business Number: 123456789RC0001
Invoice Number: INV-2023-10-045
Date: October 25, 2023
Due Date: November 25, 2023
Payment Terms: Net 30
Billed To:
Johnathan Smith
5678 Burrard Street, Apt 302
Vancouver, BC V6B 1A1, Canada
Phone: (604) 555-0123
Email: [email protected]
Insurance Provider: Blue Cross Canada
Policy Number: BC-987654321
| Service Code | Description | Date of Service | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|---|
| D0120 | Periodic Oral Evaluation (Adult) | October 20, 2023 | 1 | $85.00 | $85.00 |
| D0274 | Full Mouth Series of Radiographs | October 20, 2023 | 1 | $150.00 | $150.00 |
| D1110 | Prophylaxis (Adult Dental Cleaning) | October 20, 2023 | 1 | $120.00 | $120.00 |
| D2391 | Amalgam Restoration (2 Surfaces) | October 22, 2023 | 1 | $180.00 | $180.00 |
| D2750 | Composite Resin Restoration (2 Surfaces) | October 22, 2023 | 1 | $220.00 | $220.00 |
| D3330 | Pulp Therapy (Primary Molar) | October 24, 2023 | 1 | $350.00 | $350.00 |
| D9910 | Emergency Visit | October 24, 2023 | 1 | $75.00 | $75.00 |
| Subtotal: | $1,180.00 |
| BC Provincial Sales Tax (PST) 7%: | $82.60 |
| Harmonized Sales Tax (HST) 5%: | $59.00 |
| Total Amount Due: | $1,321.60 |
Important Notes:
This invoice is issued by Vancouver Smiles Dental Clinic, a licensed dental practice located in Vancouver, British Columbia, Canada. All services provided are in accordance with the standards set by the College of Dentists of British Columbia. Please note that dental services in Canada are not covered under the provincial health plan (MSP) for adults, and patients are responsible for payment unless covered by private insurance.
If you have dental insurance, please submit this invoice along with the detailed treatment plan to your provider for reimbursement. We can also file a claim on your behalf if you provide us with the necessary authorization and insurance details.
Payment is due within 30 days of the invoice date. Late payments may incur a 1.5% monthly interest charge. Accepted payment methods include cash, debit, credit cards (Visa, MasterCard, Amex), and electronic funds transfer (EFT).
For any questions regarding this invoice or your dental treatment, please contact our billing department at (604) 555-0199 or email [email protected]. We are committed to providing exceptional dental care and transparent billing practices to all our patients in Vancouver and the surrounding areas.
Thank you for choosing Vancouver Smiles Dental Clinic for your oral health needs. We look forward to continuing to serve you and your family.
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