Invoice Ophthalmologist in Sri Lanka Colombo –Free Word Template Download with AI

Bill To:

Mr. Arjuna Perera

12/3, Lake House Road, Colombo 07

Sri Lanka

NIC: 199012345678V

Phone: +94 77 123 4567

Description of Ophthalmological Services Rendered

This invoice details the professional fees and medical charges for the comprehensive eye care services provided by our team of certified Ophthalmologists at our clinic in Colombo, Sri Lanka. All procedures were conducted in accordance with the standards set by the Sri Lanka College of Ophthalmologists.

Item	Description of Service	Date	Amount (LKR)
1	Comprehensive Ophthalmic Consultation Initial assessment by Senior Consultant Ophthalmologist. Includes detailed medical history review, visual acuity testing, and preliminary diagnosis of refractive errors.	Oct 24, 2023	5,000.00
2	Advanced Diagnostic Imaging (OCT) Optical Coherence Tomography scan of the retina and optic nerve head to assess macular health and rule out glaucoma or diabetic retinopathy.	Oct 24, 2023	8,500.00
3	Slit-Lamp Biomicroscopy Detailed examination of the anterior segment of the eye, including the cornea, iris, and lens, to detect cataracts or corneal abrasions.	Oct 24, 2023	3,000.00
4	Intraocular Pressure Measurement (Tonometry) Goldmann applanation tonometry to measure eye pressure, a critical step in screening for glaucoma in patients residing in the Colombo metropolitan area.	Oct 24, 2023	2,500.00
5	Prescription of Corrective Lenses Detailed refraction and prescription for bifocal spectacles tailored to the patient's specific visual needs.	Oct 24, 2023	1,500.00
6	Pharmacological Treatment Supply of prescribed antibiotic eye drops and lubricating ointments for post-examination care.	Oct 24, 2023	2,000.00

Subtotal: LKR 22,500.00 VAT (18%): LKR 4,050.00 Discount (Senior Citizen): - LKR 1,000.00 Total Due: LKR 25,550.00 Payment Instructions

Please make payment within 14 days of the invoice date. Payments can be made via the following methods:

Bank Transfer: Commercial Bank of Ceylon, Colombo Branch. Account Name: Colombo Vision Specialists. Account No: 1234-5678-9012.
Credit/Debit Card: Accepted at our reception desk in Colombo 03.
Cash: Accepted in Sri Lankan Rupees (LKR) only.

Note: Please quote the Invoice Number (INV-2023-0892) in the payment reference.

Terms and Conditions

This invoice is issued by a registered medical practice in Sri Lanka and is valid for tax purposes.
Payment is due within 14 days. Late payments may incur a penalty of 1.5% per month.
All medical services provided are subject to the professional judgment of the treating Ophthalmologist.
Insurance claims should be submitted directly by the patient using this invoice as supporting documentation.
For any discrepancies regarding this invoice, please contact our billing department in Colombo within 7 days.

Authorized Signature
Dr. S. Fernando
Lead Ophthalmologist Received By
Mr. Arjuna Perera
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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