Invoice Ophthalmologist in Thailand Bangkok –Free Word Template Download with AI

Bill To:

Mr. John Doe

45/8 Wireless Road, Lumpini

Pathum Wan, Bangkok 10330, Thailand

Phone: +66 89 123 4567

Email: [email protected]

Invoice Details:

Invoice Number: INV-BKK-2023-0045

Date of Issue: October 24, 2023

Date of Service: October 24, 2023

Due Date: Upon Receipt

Attending Ophthalmologist: Dr. Somchai Visionary, M.D.

#	Description of Ophthalmology Services	Quantity	Unit Price (THB)	Total (THB)
1	Comprehensive Ophthalmic Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and intraocular pressure measurement (Tonometry) performed by a certified Ophthalmologist in Bangkok.	1	2,500.00	2,500.00
2	Dilated Fundus Examination Detailed inspection of the retina, optic nerve, and macula using mydriatic drops to ensure thorough diagnosis of posterior segment pathology.	1	1,200.00	1,200.00
3	Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to detect macular degeneration, glaucoma, or diabetic retinopathy.	1	3,000.00	3,000.00
4	Corneal Topography Mapping of the anterior surface of the cornea to assess curvature and detect irregularities such as keratoconus.	1	2,000.00	2,000.00
5	Prescription Eyewear Consultation Final determination of refractive error and prescription for corrective lenses.	1	500.00	500.00

Subtotal: 9,200.00 THB VAT (7%): 644.00 THB Total Amount Due: 9,844.00 THB

Payment Terms and Conditions

This Invoice represents the total cost for the ophthalmological services rendered at our clinic in Thailand Bangkok. Payment is due immediately upon receipt of this document. We accept payments via bank transfer, credit card, or cash at our front desk.

Bank Transfer Details:
Bank: Bangkok Bank
Account Name: Bangkok Vision Specialists Co., Ltd.
Account Number: 123-4-56789-0
SWIFT Code: BKKBTHBK

Please reference your Invoice Number (INV-BKK-2023-0045) when making a payment. For insurance claims, please contact our billing department directly with a copy of this invoice and your policy details.

Medical Disclaimer:
The services described herein were provided by a licensed Ophthalmologist specializing in eye care. This invoice is for administrative and financial purposes only and does not constitute a medical diagnosis or treatment plan. Please refer to your discharge summary for medical details.

Thank you for choosing Bangkok Vision Specialists for your eye care needs in Thailand. We are committed to providing world-class ophthalmology services in the heart of Bangkok.

Authorized Signature
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