Invoice Dentist in Sri Lanka Colombo –Free Word Template Download with AI
Specialists in Restorative & Cosmetic Dentistry
No. 45, Galle Road, Colombo 03, Sri Lanka
Phone: +94 11 234 5678 | Email: [email protected]
VAT Registration No: 123456789V
Invoice No: INV-2023-0892
Date: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To:
Mr. Arjuna Perera
12/3, Dehiwala Mawatha, Colombo 10, Sri Lanka
NIC: 198567891234
Phone: +94 77 123 4567
| # | Description of Dental Services | Date of Service | Unit Price (LKR) | Total (LKR) |
|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination & Consultation Includes full oral health assessment, periodontal charting, and treatment planning consultation by senior dentist. |
Oct 24, 2023 | 5,000.00 | 5,000.00 |
| 2 |
Full Mouth Digital X-Rays (OPG & Bitewings) Radiographic imaging to assess bone structure, root health, and hidden cavities. |
Oct 24, 2023 | 3,500.00 | 3,500.00 |
| 3 |
Professional Scaling and Polishing (Upper & Lower) Ultrasonic scaling to remove calculus and tartar buildup, followed by prophylaxis polishing. |
Oct 24, 2023 | 8,000.00 | 8,000.00 |
| 4 |
Composite Resin Filling (Tooth #16) Removal of decay and restoration using tooth-colored composite material. Includes local anesthesia. |
Oct 24, 2023 | 12,000.00 | 12,000.00 |
| 5 |
Root Canal Treatment (RCT) - Single Root (Tooth #31) Endodontic therapy including access, cleaning, shaping, and obturation of the root canal system. |
Oct 24, 2023 | 25,000.00 | 25,000.00 |
| 6 |
Provisional Crown (Temporary) Fabrication and cementation of temporary acrylic crown for protection during final crown preparation. |
Oct 24, 2023 | 4,500.00 | 4,500.00 |
| 7 |
Prescription Medication Antibiotics (Amoxicillin 500mg) and Analgesics (Ibuprofen 400mg) for post-procedure care. |
Oct 24, 2023 | 1,200.00 | 1,200.00 |
Amount in words: Sixty-One Thousand Nine Hundred Thirty-Six Sri Lankan Rupees Only.
Payment Instructions
Please make payment within 14 days of the invoice date. We accept the following payment methods:
- Bank Transfer: Commercial Bank of Ceylon, Colombo Branch. Account Name: Colombo Elite Dental Care (Pvt) Ltd. Account No: 1234-5678-9012-3456.
- Credit/Debit Card: Visa, Mastercard, and UnionPay accepted at the clinic reception.
- Cash: Sri Lankan Rupees (LKR) accepted at the clinic.
Please quote the Invoice Number (INV-2023-0892) as the payment reference.
Terms and Conditions
- This invoice is issued by Colombo Elite Dental Care, a registered dental practice in Colombo, Sri Lanka, in accordance with the Sri Lanka Dental Council regulations.
- All prices are inclusive of professional fees and materials unless otherwise stated. VAT is charged as per the Inland Revenue Department of Sri Lanka guidelines.
- Payment is due within 14 days. Late payments may incur a penalty interest of 1.5% per month on the outstanding balance.
- This invoice serves as a receipt for insurance claims. Please retain this document for your records.
- Any disputes regarding this invoice must be raised within 7 days of receipt. Contact our billing department at [email protected].
- Future appointments for crown cementation or follow-up care must be scheduled separately and will be invoiced accordingly.
Authorized Signature
Dr. Nimal Senanayake
Lead Dentist & Owner
Colombo Elite Dental Care
Received By
__________________________
Date: ____________________
Thank you for choosing Colombo Elite Dental Care for your oral health needs.
Registered in Sri Lanka | VAT No: 123456789V | Dental Council Reg: DC/SL/2023/456
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