Invoice Dentist in United Kingdom London –Free Word Template Download with AI
123 Harley Street, Marylebone
London, W1G 7AA
United Kingdom
Tel: +44 (0)20 7123 4567
Email: [email protected]
GDC Number: 123456
Invoice Number: INV-2023-10-892
Date of Issue: 24 October 2023
Date of Service: 20 October 2023
Due Date: 24 November 2023
Bill To
Mr. Jonathan Sterling
45 Kensington Gardens Square
Kensington, London
W2 4BH
United Kingdom
Patient Details
Patient Name: Mr. Jonathan Sterling
NHS Number: 485 777 222 11
Date of Birth: 15 March 1985
NHS Status: Private Patient
| Ref | Description of Dental Treatment | Code | Unit Price (£) | Total (£) |
|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination Includes full oral health assessment, periodontal charting, and discussion of treatment options in accordance with British Dental Association guidelines. |
A01 | 85.00 | 85.00 |
| 2 |
Full Mouth Radiographic Survey Digital panoramic X-ray and bitewing radiographs to assess bone levels and detect interproximal caries. |
R02 | 120.00 | 120.00 |
| 3 |
Professional Hygiene and Scale & Polish Ultrasonic scaling, hand instrumentation, and air-polishing to remove calculus and plaque deposits. |
H05 | 110.00 | 110.00 |
| 4 |
Composite Resin Restoration (Tooth 36) Removal of decay and placement of aesthetic composite filling on the lower left first molar. |
F12 | 175.00 | 175.00 |
| 5 |
Root Canal Treatment (Tooth 11) Endodontic therapy for the upper right central incisor including access, cleaning, shaping, and obturation. |
E08 | 450.00 | 450.00 |
| 6 |
Emergency Consultation Fee Assessment of acute dental pain and immediate management. |
EMG | 65.00 | 65.00 |
| Subtotal | £1,005.00 |
| VAT (20%) | £201.00 |
| TOTAL DUE | £1,206.00 |
Payment Instructions & Terms
Please ensure payment is made within 30 days of the invoice date. Late payments may incur interest charges in accordance with the Late Payment of Commercial Debts (Interest) Act 1998.
Bank Transfer Details:
Bank Name: Barclays Bank UK PLC
Account Name: London Premier Dental Care Ltd
Sort Code: 20-00-00
Account Number: 12345678
Reference: INV-2023-10-892
Card Payments: We accept Visa, Mastercard, and American Express. Please contact our reception team to arrange a secure card payment over the phone.
NHS vs Private: This invoice reflects private dental treatment costs. As such, it is not covered by the National Health Service (NHS) banding system. If you have private dental insurance, please submit this invoice directly to your provider for reimbursement.
Regulatory Compliance: London Premier Dental Care operates under the strict regulations of the General Dental Council (GDC) and complies with all United Kingdom data protection laws (GDPR). Your medical records are stored securely in London.
Authorised By:
Dr. Sarah Jenkins, BDS, MSc
Principal Dentist
Received By:
__________________________
Date: ____________________
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