Invoice Dentist in Uganda Kampala –Free Word Template Download with AI
Providing World-Class Dental Care in the Heart of Uganda
Address: Plot 45, Kololo Avenue, Kampala, Uganda
Phone: +256 700 123 456
Email: [email protected]
TIN: 1234567890
Invoice Number: KE-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To (Patient)
Name: Mr. James Okello
Address: House 12, Nakasero Hill, Kampala, Uganda
Phone: +256 772 987 654
Email: [email protected]
NHIS ID: UG-NHIS-998877
Pay From (Provider)
Provider: Dr. Sarah Nalubega, DDS
Specialty: Prosthodontics & Cosmetic Dentistry
Licence No: UDC-REG-2015-445
Clinic: Kampala Elite Dental Clinic
| # | Description of Dental Services | Date of Service | Quantity | Unit Price (UGX) | Total (UGX) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination & Consultation Includes full oral health assessment, periodontal charting, and treatment planning discussion at our Kampala facility. |
Oct 24, 2023 | 1 | 150,000 | 150,000 |
| 2 |
Full Mouth Digital X-Rays (OPG & Bitewings) Advanced radiographic imaging to assess bone structure and tooth decay. |
Oct 24, 2023 | 1 | 200,000 | 200,000 |
| 3 |
Professional Scaling and Polishing (Deep Cleaning) Removal of tartar and plaque buildup above and below the gum line to prevent periodontal disease. |
Oct 24, 2023 | 1 | 350,000 | 350,000 |
| 4 |
Composite Resin Filling (Tooth #14) Restoration of decayed molar using tooth-colored composite material for aesthetic and functional integrity. |
Oct 24, 2023 | 1 | 450,000 | 450,000 |
| 5 |
Root Canal Therapy (Tooth #21) Endodontic treatment to save infected tooth. Includes cleaning, shaping, and filling of root canals. |
Oct 24, 2023 | 1 | 1,200,000 | 1,200,000 |
| 6 |
Porcelain Crown Fabrication and Placement Custom-made ceramic crown for Tooth #21 to restore strength and appearance. |
Oct 24, 2023 | 1 | 1,500,000 | 1,500,000 |
| 7 |
Local Anesthesia and Medication Includes lidocaine injection and post-operative antibiotics/pain relief prescription. |
Oct 24, 2023 | 1 | 100,000 | 100,000 |
Payment Methods Accepted in Kampala
We accept various payment methods to ensure convenience for our patients in Uganda:
- Mobile Money: MTN MoMo / Airtel Money to +256 700 123 456
- Bank Transfer: Stanbic Bank Uganda, Account No: 100234567890
- Cash: Ugandan Shillings (UGX) accepted at the clinic reception.
- Cards: Visa/Mastercard accepted via terminal.
Please quote Invoice Number KE-2023-0892 when making payment.
Terms and Conditions
- Payment Terms: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
- Validity: This invoice is valid for services rendered at Kampala Elite Dental Clinic only.
- Insurance: If you have dental insurance coverage in Uganda, please submit this invoice along with your claim form to your provider.
- Disputes: Any discrepancies regarding this invoice must be reported within 7 days of receipt.
- Follow-up: A follow-up appointment is recommended in 6 months for routine check-up to maintain oral health.
Thank you for choosing Kampala Elite Dental Clinic for your dental care needs in Uganda.
Authorized Signature (Clinic)
Dr. Sarah Nalubega
Lead Dentist
Patient Acknowledgement
Mr. James Okello
Date: _______________
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