Invoice Dentist in India Mumbai –Free Word Template Download with AI

Bill To:

Patient Name: Mr. Amit Patel

Address: Flat 12B, Sea View Apartments,

Andheri West, Mumbai, Maharashtra 400058, India

Phone: +91 98765 43210

PAN: ABCDE1234F

Payment Details:

Bank Name: HDFC Bank

Branch: Bandra West, Mumbai

Account Name: Mumbai Smile Dental Clinic

Account No: 50200012345678

IFSC Code: HDFC0001234

#	Description of Dental Services	HSN/SAC	Qty	Rate (INR)	Amount (INR)
1	Comprehensive Dental Consultation & Examination Initial assessment of oral health, review of medical history, and formulation of treatment plan for orthodontic correction.	999511	1	1,500.00	1,500.00
2	Full Mouth Digital X-Ray (OPG) & Panoramic Scan Diagnostic imaging required for precise alignment analysis and root structure evaluation.	999511	1	2,000.00	2,000.00
3	Professional Scaling and Polishing (Deep Cleaning) Removal of calculus and plaque buildup to ensure gum health prior to appliance fitting.	999511	1	3,500.00	3,500.00
4	Composite Filling (Tooth #14) Restoration of decayed molar using tooth-colored composite resin material.	999511	1	2,500.00	2,500.00
5	Orthodontic Bracket Placement (Upper Arch) Application of ceramic self-ligating brackets for aesthetic alignment.	999511	1	15,000.00	15,000.00
6	Orthodontic Bracket Placement (Lower Arch) Application of ceramic self-ligating brackets for aesthetic alignment.	999511	1	15,000.00	15,000.00
7	Archwires and Ligatures (Initial Set) Stainless steel and nickel-titanium wires for initial alignment phase.	999511	1	4,000.00	4,000.00

Subtotal: ₹ 43,500.00 Discount (5% Senior Citizen/Early Bird): - ₹ 2,175.00 Taxable Amount: ₹ 41,325.00 GST @ 18% (CGST 9% + SGST 9%): ₹ 7,438.50 Total Payable (INR): ₹ 48,763.50

Amount in words: Indian Rupees Forty-Eight Thousand Seven Hundred Sixty-Three and Paise Fifty Only.

Terms and Conditions:

This invoice is computer-generated and valid for payment in Mumbai, India.
Payment is due within 15 days of the invoice date. Late payments may incur a 2% monthly interest charge.
Services rendered are subject to the standard warranty policies of Mumbai Smile Dental Clinic.
Orthodontic treatment requires regular follow-up visits; missed appointments may affect treatment duration.
GST is applicable as per the Government of India tax laws for healthcare services involving medical devices.
For any discrepancies, please contact our billing department within 7 days.

Thank you for choosing Mumbai Smile Dental Clinic for your oral healthcare needs.

Authorized Signatory
Mumbai Smile Dental Clinic Patient Signature
(Acknowledging Receipt) ⬇️ Download as DOCX Edit online as DOCX

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