Invoice Dentist in Israel Tel Aviv –Free Word Template Download with AI
123 Rothschild Boulevard
Tel Aviv-Yafo, Israel 6688101
Phone: +972-3-555-1234
Email: [email protected]
VAT ID: 512345678
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: November 15, 2024
Payment Terms: Net 30 Days
Patient Name: David Cohen
Address: 45 Allenby Street, Apartment 7
City: Tel Aviv, Israel 6789012
Phone: +972-50-123-4567
Email: [email protected]
National ID (Teudat Zehut): 123456789
Insurance Provider: Maccabi Healthcare Services
Policy Number: MAC-987654321
This invoice is issued by Tel Aviv Advanced Dental Clinic, a licensed dental practice operating in Tel Aviv, Israel. Our clinic is registered with the Israeli Dental Association and complies with all national healthcare regulations. All services rendered are performed by certified dentists and dental specialists adhering to the highest standards of care recognized in Israel.
Description of Dental Services Rendered:The following dental services were provided to the patient at our Tel Aviv clinic during the treatment period specified below. Each procedure was performed by a qualified dentist after a thorough clinical examination and consultation. All treatments comply with the professional standards set by the Israeli Ministry of Health and the Israel Dental Association.
Treatment Period: September 1, 2024 – October 10, 2024
Treating Dentist: Dr. Sarah Levi, DDS
Clinic Location: Tel Aviv-Yafo, Israel
| Date | Service Description | Procedure Code | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|---|
| 2024-09-05 | Comprehensive Dental Examination and Consultation | D0150 | 1 | 350.00 | 350.00 |
| 2024-09-05 | Full Mouth Panoramic X-Ray | D0330 | 1 | 450.00 | 450.00 |
| 2024-09-12 | Professional Dental Cleaning (Prophylaxis) | D1110 | 1 | 500.00 | 500.00 |
| 2024-09-19 | Composite Filling (Tooth #14) | D2391 | 1 | 750.00 | 750.00 |
| 2024-09-26 | Root Canal Treatment (Tooth #19) | D3330 | 1 | 2,200.00 | 2,200.00 |
| 2024-10-03 | Dental Crown Preparation and Temporary Crown | D2740 | 1 | 1,800.00 | 1,800.00 |
| 2024-10-10 | Final Crown Placement (Zirconia) | D2750 | 1 | 3,500.00 | 3,500.00 |
| 2024-10-10 | Follow-Up Examination and Adjustment | D0120 | 1 | 250.00 | 250.00 |
| Subtotal: | 9,800.00 ILS | ||||
| VAT (17%): | 1,666.00 ILS | ||||
| Total Amount Due: | 11,466.00 ILS | ||||
Payment is due within 30 days from the date of this invoice. Please include the invoice number (INV-2024-0892) as a reference when making your payment. Payments can be made via bank transfer, credit card, or in person at our Tel Aviv clinic.
Bank Transfer Details:
Bank: Bank Hapoalim
Branch: Tel Aviv Central
Account Name: Tel Aviv Advanced Dental Clinic Ltd.
Account Number: 99999-123456-7
SWIFT Code: HAPoilmm
For credit card payments, please contact our billing department at +972-3-555-1234 or email [email protected].
Insurance and Reimbursement:This invoice is issued in accordance with Israeli dental billing standards. If you have dental insurance coverage, please submit this invoice along with your treatment records to your insurance provider for reimbursement. Our clinic can provide additional documentation if required by your insurer.
Terms and Conditions:
1. All services were rendered at our clinic in Tel Aviv, Israel, by licensed dental professionals.
2. Prices are quoted in Israeli New Shekels (ILS) and include applicable VAT as per Israeli tax law.
3. Late payments may incur a monthly interest charge of 1.5% on the outstanding balance.
4. Any disputes regarding this invoice must be raised within 14 days of receipt.
5. This invoice serves as an official record of dental services provided and may be used for insurance, tax, or personal records.
___________________________
Dr. Sarah Levi, DDS
Lead Dentist
Tel Aviv Advanced Dental Clinic
Date: October 15, 2024
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