Invoice Optometrist in Canada Vancouver –Free Word Template Download with AI
Professional Optometrists & Eye Care Specialists
1234 West Georgia Street, Suite 500
Vancouver, BC V6E 4R2
Canada
Phone: (604) 555-0199 | Email: [email protected]
BC College of Optometrists Reg. #12345
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Payment Status: Pending
Bill To:
Mr. James Anderson
789 Granville Island Way
Vancouver, BC V6H 3S8
Canada
Phone: (604) 555-0123
Email: [email protected]
Service Details:
Date of Service: October 24, 2023
Provider: Dr. Sarah Chen, O.D.
Insurance Provider: Blue Cross BC
Policy Number: BC-987654321
Group Number: GRP-555
| Description of Services | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|
|
Comprehensive Eye Examination Includes visual acuity testing, refraction, intraocular pressure measurement, and dilated fundus examination. Performed by a licensed Optometrist in accordance with British Columbia standards. |
1 | $150.00 | $150.00 |
|
Advanced Retinal Imaging (Optos) Wide-field retinal photography to assess the health of the retina and optic nerve. Essential for early detection of diabetic retinopathy and glaucoma. |
1 | $75.00 | $75.00 |
|
Prescription Lenses (High Index 1.67) Pair of single-vision lenses with anti-reflective coating and UV protection. Custom ground to prescription. |
1 | $220.00 | $220.00 |
|
Designer Eyeglass Frames Titanium full-rim frame, Model: Titan-X400. Includes adjustment and fitting. |
1 | $180.00 | $180.00 |
|
Contact Lens Fitting & Evaluation Initial fitting for daily disposable soft contact lenses, including corneal topography and trial lens assessment. |
1 | $100.00 | $100.00 |
|
30-Day Supply of Contact Lenses Daily disposable soft contact lenses (Box of 30). |
1 | $45.00 | $45.00 |
| Subtotal: | $770.00 |
| BC Provincial Tax (GST/HST): | $0.00 |
| Insurance Coverage Applied: | -$450.00 |
| Total Due (CAD): | $320.00 |
Payment Instructions & Terms:
Thank you for choosing Vancouver Vision Care for your eye health needs. This invoice reflects the professional services provided by our licensed Optometrists in Vancouver, British Columbia. Payment is due within 30 days of the invoice date. We accept payments via credit card (Visa, MasterCard, Amex), Interac e-Transfer, debit, and cash. For online payments, please visit our secure portal at www.vancouvervisioncare.ca/pay. Please include your Invoice Number (INV-2023-10-045) as the reference when making a payment.
Insurance Claims: We have submitted your claim directly to your insurance provider. The amount shown as "Insurance Coverage Applied" is an estimate based on your provided policy details. If your insurance reimbursement differs, you will be responsible for any balance due. Please contact our billing department if you have questions about your coverage.
Privacy Notice: Your personal health information is protected under the Personal Information Protection and Electronic Documents Act (PIPEDA) and British Columbia's Personal Information Protection Act (PIPA). We maintain strict confidentiality regarding all patient records and financial data.
Follow-Up Care: As recommended by your Optometrist, please schedule your next comprehensive eye exam in 12 months. Regular eye examinations are crucial for maintaining optimal vision and detecting systemic health issues early.
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