Invoice Dentist in Japan Kyoto –Free Word Template Download with AI
1-2-3 Shijo-Dori, Higashiyama-ku
Kyoto, Japan 605-0073
Tel: +81-75-555-0199
Email: [email protected]
Corporate Number: 605000100123456
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Method: Bank Transfer / Credit Card
Bill To
Mr. Alexander Smith INT-EXPAT-998877 4-5-6 Gion-Machi, Higashiyama-kuKyoto, Japan 605-0074 +81-90-1234-5678
| # | Description of Dental Services | Date of Service | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
| 1 |
Comprehensive Oral Examination & Consultation Initial assessment of oral health status, periodontal screening, and discussion of treatment plan. Includes digital panoramic X-ray imaging. |
Oct 10, 2023 | ¥15,000 | ¥15,000 |
| 2 |
Professional Dental Cleaning (Prophylaxis) Ultrasonic scaling and polishing to remove plaque and tartar buildup. Includes fluoride treatment application. |
Oct 10, 2023 | ¥12,000 | ¥12,000 |
| 3 |
Composite Resin Filling (Tooth #14) Restoration of a Class II cavity using high-quality aesthetic composite material. Includes local anesthesia and post-operative check. |
Oct 17, 2023 | ¥25,000 | ¥25,000 |
| 4 |
Root Canal Therapy (Tooth #36) Endodontic treatment for a single-rooted tooth. Includes cleaning, shaping, and obturation of the root canal system. |
Oct 20, 2023 | ¥60,000 | ¥60,000 |
| 5 |
Porcelain Crown Fabrication & Placement Custom-made zirconia crown for Tooth #36. Includes impression taking, temporary crown, and final cementation. |
Oct 24, 2023 | ¥120,000 | ¥120,000 |
| 6 |
Follow-up Consultation Post-treatment evaluation to ensure proper healing and occlusion adjustment. |
Oct 24, 2023 | ¥5,000 | ¥5,000 |
Payment Instructions & Important Notes
Bank Transfer Details:
Bank Name: Kyoto Bank
Branch: Shijo Branch
Account Type: Ordinary
Account Number: 1234567
Account Name: Kyoto Central Dental Clinic
Terms and Conditions:
1. Payment is due within 30 days of the invoice date.
2. Please include the Invoice Number (INV-2023-10-045) in the payment reference.
3. This invoice is issued in accordance with Japanese tax laws. The consumption tax rate of 10% applies to all services rendered.
4. For international patients in Kyoto, we accept major credit cards (Visa, Mastercard, JCB) and cash payments in Japanese Yen.
5. If you have private dental insurance, please submit this invoice along with the detailed treatment report to your provider for reimbursement.
6. Late payments may incur a penalty fee of 1.5% per month on the outstanding balance.
Thank You:
Thank you for choosing Kyoto Central Dental Clinic for your oral health needs. We are committed to providing world-class dental care in the heart of Kyoto. If you have any questions regarding this invoice or your treatment, please do not hesitate to contact our billing department.
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