Invoice Dentist in Egypt Alexandria –Free Word Template Download with AI
Specialized Dental Care & Orthodontics
123 Saad Zaghloul Street, Sporting District
Alexandria, Egypt
Tel: +20 3 480 1234 | Email: [email protected]
Tax ID: 123-456-789000
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Bill To (Patient)
Name: Ahmed Mohamed Hassan
Address: 45 El-Horreya Avenue, Smouha
City: Alexandria, Egypt
Phone: +20 10 1234 5678
Insurance: Bupa Egypt (Policy #998877)
Payment Information
Bank Name: National Bank of Egypt (NBE)
Branch: Sporting Branch, Alexandria
Account Name: Alexandria Smile Dental Clinic
IBAN: EG39 0019 0005 0000 0000 1234 56
Currency: Egyptian Pound (EGP)
| # | Description of Dental Services | Code | Qty | Unit Price (EGP) | Total (EGP) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Consultation in Alexandria Clinic | D0150 | 1 | 500.00 | 500.00 |
| 2 | Full Mouth Panoramic X-Ray (OPG) & Digital Imaging | D0330 | 1 | 800.00 | 800.00 |
| 3 | Professional Dental Cleaning (Scaling & Polishing) - Upper & Lower | D1110 | 1 | 1,200.00 | 1,200.00 |
| 4 | Composite Resin Filling (Tooth #19) - Anterior Tooth | D2391 | 1 | 1,500.00 | 1,500.00 |
| 5 | Root Canal Therapy (Endodontics) - Single Root (Tooth #30) | D3310 | 1 | 3,500.00 | 3,500.00 |
| 6 | Porcelain Crown Preparation & Temporary Crown Placement | D2740 | 1 | 4,000.00 | 4,000.00 |
| 7 | Extraction of Impacted Wisdom Tooth (Surgical) - Lower Right | D7210 | 1 | 2,500.00 | 2,500.00 |
| 8 | Prescription Medication (Antibiotics & Pain Management) | RX-001 | 1 | 350.00 | 350.00 |
Terms and Conditions & Important Notes
This invoice serves as an official record of dental services rendered by Alexandria Smile Dental Clinic, located in the heart of Alexandria, Egypt. All prices are listed in Egyptian Pounds (EGP) and are subject to the prevailing Value Added Tax (VAT) regulations enforced by the Egyptian Tax Authority.
Payment Terms: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month. We accept cash, credit cards (Visa/Mastercard), and bank transfers. For large procedures such as implants or full-mouth rehabilitation, a 50% deposit is required prior to commencement of treatment.
Insurance Claims: If you are using private health insurance, please submit this invoice along with the detailed treatment plan and X-rays to your insurance provider. Our clinic staff in Alexandria can assist you in preparing the necessary documentation for reimbursement.
Warranty: All dental restorations, including crowns, bridges, and fillings, come with a 12-month warranty against material defects or workmanship issues, provided that the patient adheres to the recommended oral hygiene instructions and attends regular check-ups.
Privacy Policy: In accordance with Egyptian medical law, all patient records and financial data are kept strictly confidential. This invoice contains sensitive personal information and should be handled with care.
Thank you for choosing Alexandria Smile Dental Clinic for your oral health needs. We are committed to providing world-class dental care in Alexandria, Egypt.
Authorized Signature
Dr. Sarah El-Sayed
Lead Dentist & Clinic Manager
Patient Acknowledgement
Signature:
Date:
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