Invoice Dentist in Italy Rome –Free Word Template Download with AI
Dr. Alessandro Rossi
Via del Corso, 123
00186 Roma RM, Italy
P.IVA / C.F.: IT01234567890
Email: [email protected]
Phone: +39 06 1234 5678
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Billed To:
Mr. James Smith
Via dei Condotti, 45
00187 Roma RM, Italy
Email: [email protected]
Phone: +39 333 1234567
Service Details:
Appointment Date: October 20, 2023
Treatment Plan ID: TP-8892
Insurance Provider: None (Private Pay)
Referral Code: N/A
| # | Description of Dental Services | Code | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination Includes full oral health assessment, periodontal charting, and consultation regarding treatment options for the upper right quadrant. Performed in accordance with Italian dental hygiene standards. |
EXAM-01 | 1 | 80.00 | 80.00 |
| 2 |
Full Mouth Digital Radiography Panoramic X-ray and periapical images to assess bone density and root health. Essential for planning the subsequent restorative work in the Rome clinic. |
RAD-05 | 1 | 60.00 | 60.00 |
| 3 |
Professional Dental Cleaning (Prophylaxis) Ultrasonic scaling and polishing to remove tartar and plaque buildup. Includes fluoride treatment to strengthen enamel against decay. |
CLEAN-02 | 1 | 120.00 | 120.00 |
| 4 |
Composite Resin Filling (Tooth #16) Restoration of a Class II cavity on the upper right first molar using high-quality aesthetic composite material. Includes local anesthesia and post-operative check. |
FILL-03 | 1 | 150.00 | 150.00 |
| 5 |
Root Canal Therapy (Tooth #36) Endodontic treatment for the lower left first molar. Includes removal of infected pulp, cleaning of canals, and temporary sealing. Performed by specialist endodontist. |
ROOT-07 | 1 | 450.00 | 450.00 |
| 6 |
Porcelain Crown Preparation (Tooth #36) Preparation of the tooth structure for a permanent crown following root canal therapy. Includes impression taking and temporary crown placement. |
CROWN-01 | 1 | 200.00 | 200.00 |
| 7 |
Consultation for Orthodontic Evaluation Initial assessment for potential Invisalign treatment. Includes digital smile design and discussion of alignment options available at our Rome facility. |
ORTHO-01 | 1 | 100.00 | 100.00 |
Payment Terms and Conditions:
Payment is due within 30 days of the invoice date. Please include the invoice number (INV-2023-10-045) as a reference for all payments. Late payments may incur a penalty fee of 1.5% per month in accordance with Italian law (Legge 192/2000).
Bank Transfer Details:
Bank: Banca Intesa Sanpaolo
IBAN: IT60 X054 2811 1010 0000 0123 456
SWIFT/BIC: BCITITMM
Beneficiary: Studio Dentistico Roma Centro s.r.l.
Important Notice:
This invoice serves as an official receipt for services rendered at our dental clinic in Rome, Italy.
All treatments were performed following the guidelines of the Italian Dental Association (ODI).
Please retain this document for your personal records and for any potential reimbursement claims with your private health insurance provider.
If you have any questions regarding the charges or the treatment plan, please contact our administrative office during business hours (Monday-Friday, 9:00 AM - 7:00 PM).
Thank you for choosing Studio Dentistico Roma Centro for your oral health needs. We are committed to providing exceptional dental care in the heart of Rome.
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