Invoice Dentist in Ethiopia Addis Ababa –Free Word Template Download with AI
Professional Dental Services in Ethiopia
Bole Sub-City, Woreda 03, House No. 456
Addis Ababa, Ethiopia
Tel: +251 11 618 7890 | Email: [email protected]
TIN: 1002345678
Invoice No: ADC-2024-0892
Date: October 15, 2024
Due Date: October 22, 2024
| Bill To: |
Mr. Kebede Tadesse Patient ID: PT-2024-3456 Kebele 12, House No. 78 Yeka Sub-City, Addis Ababa Ethiopia Phone: +251 911 234 567 |
| Treatment Date: | October 10, 2024 |
| Attending Dentist: | Dr. Abebe Mekonnen, DDS |
| Payment Method: | Cash / Bank Transfer (CBE, Awash Bank) |
Patient Information & Consent
This invoice is issued for dental services rendered at Addis Dental Care Center, located in Addis Ababa, Ethiopia. The patient, Mr. Kebede Tadesse, has consented to the procedures outlined below after consultation with our licensed dentist. All treatments comply with the standards set by the Ethiopian Food and Drug Authority (EFDA) and the Ministry of Health.
| # | Description of Dental Service | Qty | Unit Price (ETB) | Total (ETB) |
|---|---|---|---|---|
| 1 | Comprehensive Dental Examination and Consultation | 1 | 500.00 | 500.00 |
| 2 | Full Mouth Panoramic X-Ray | 1 | 800.00 | 800.00 |
| 3 | Professional Dental Cleaning (Scaling and Polishing) | 1 | 1,200.00 | 1,200.00 |
| 4 | Composite Filling (Tooth #14) - Front Tooth | 1 | 2,500.00 | 2,500.00 |
| 5 | Root Canal Treatment (Tooth #36) - Molar | 1 | 4,500.00 | 4,500.00 |
| 6 | Porcelain Crown (Tooth #36) - High-Quality Material | 1 | 6,000.00 | 6,000.00 |
| 7 | Local Anesthesia (Lidocaine with Epinephrine) | 2 | 150.00 | 300.00 |
| 8 | Antibiotics Prescription (Amoxicillin 500mg) | 1 | 200.00 | 200.00 |
| 9 | Pain Relief Medication (Ibuprofen 400mg) | 1 | 150.00 | 150.00 |
| 10 | Follow-Up Consultation (Post-Treatment Check) | 1 | 300.00 | 300.00 |
| Subtotal: | 16,450.00 ETB |
| VAT (15%): | 2,467.50 ETB |
| Total Amount Due: | 18,917.50 ETB |
Important Notes & Payment Instructions
1. This invoice is valid for payment within 7 days from the date of issue. Late payments may incur a 2% monthly interest charge as per Ethiopian commercial law.
2. Payment can be made in Ethiopian Birr (ETB) via cash at our clinic in Addis Ababa, or through bank transfer to the following accounts:
- Commercial Bank of Ethiopia (CBE): Account No. 1000123456789, Branch: Bole
- Awash International Bank: Account No. 2000987654321, Branch: Megenagna
3. Please reference the invoice number (ADC-2024-0892) when making a bank transfer.
4. All dental materials used are imported and certified by the Ethiopian Food and Drug Authority (EFDA).
5. This invoice serves as an official receipt upon payment confirmation. Please retain it for your records and insurance purposes.
6. For any questions regarding this invoice or your dental treatment, please contact our office in Addis Ababa during working hours (Monday to Saturday, 8:00 AM - 6:00 PM).
7. Addis Dental Care Center is committed to providing high-quality dental services in Ethiopia. We thank you for trusting us with your oral health.
Authorized Signature
Dr. Abebe Mekonnen
Lead Dentist
Patient Signature
Mr. Kebede Tadesse
Date: _______________
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