Invoice Optometrist in Brazil Brasília –Free Word Template Download with AI
Professional Optometric Services
Address: SIA Trecho 4, Lote 589, Asa Norte, Brasília - DF, Brazil
Phone: +55 (61) 3333-4444
Email: [email protected]
CNPJ: 12.345.678/0001-90
Invoice Number: INV-2023-0892
Date Issued: October 15, 2023
Due Date: October 30, 2023
Payment Terms: Net 15 Days
Bill To:Client Name: Maria Silva Santos
Address: SQS 308 Bloco A, Asa Sul, Brasília - DF, Brazil
Phone: +55 (61) 99999-8888
Email: [email protected]
CPF: 123.456.789-00
Service Details:This invoice covers professional optometric services rendered in Brasília, Brazil, including comprehensive eye examinations, prescription updates, and specialized vision care consultations. All services were performed in accordance with Brazilian health regulations and professional standards for optometry practice.
Services Rendered:| Description | Quantity | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|
| Comprehensive Eye Examination - Adult Patient | 1 | R$ 250.00 | R$ 250.00 |
| Refraction Test and Prescription Update | 1 | R$ 150.00 | R$ 150.00 |
| Dilated Eye Examination | 1 | R$ 180.00 | R$ 180.00 |
| Glaucoma Screening Test | 1 | R$ 120.00 | R$ 120.00 |
| Macular Degeneration Assessment | 1 | R$ 200.00 | R$ 200.00 |
| Binocular Vision Assessment | 1 | R$ 175.00 | R$ 175.00 |
| Contact Lens Fitting and Evaluation | 1 | R$ 220.00 | R$ 220.00 |
| Low Vision Consultation | 1 | R$ 300.00 | R$ 300.00 |
| Digital Eye Strain Assessment | 1 | R$ 130.00 | R$ 130.00 |
| Pediatric Vision Screening (Dependent) | 1 | R$ 160.00 | R$ 160.00 |
| Subtotal: | R$ 1,885.00 |
| Discount (5% Loyalty Program): | -R$ 94.25 |
| Service Tax (ISS - Brasília): | R$ 89.54 |
| Total Amount Due: | R$ 1,880.29 |
Payment can be made via bank transfer, PIX (Brazilian instant payment system), or credit card. Please include the invoice number as reference.
Bank Details:
Bank: Banco do Brasil
Account Number: 12345-6
Agency: 0001
PIX Key: [email protected]
Important: Late payments may incur a penalty of 2% per month plus interest of 1% per month, in accordance with Brazilian commercial law.
Terms and Conditions:1. This invoice represents professional optometric services provided in Brasília, Federal District, Brazil.
2. All services were performed by licensed optometrists registered with the Brazilian Council of Optometry.
3. Payment is due within 15 days from the invoice date.
4. In case of disputes, the parties agree to resolve matters through the Consumer Protection Agency (PROCON) of Brasília.
5. This document serves as official proof of payment for insurance reimbursement purposes.
6. Please retain this invoice for your records and tax purposes.
Additional Information:Brasília Vision Care Optometry is committed to providing high-quality eye care services to the residents of Brasília and the Federal District. Our team of experienced optometrists uses state-of-the-art equipment to ensure accurate diagnoses and effective treatment plans. We accept most major health insurance plans and offer flexible payment options for uninsured patients.
For any questions regarding this invoice or our services, please contact our billing department at +55 (61) 3333-4444 or email [email protected]. Our office is located in the Asa Norte district of Brasília, easily accessible by public transportation and major highways.
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