Invoice Optometrist in China Guangzhou –Free Word Template Download with AI
Address: Room 1205, Zhujiang New Town International Finance Center, Tianhe District, Guangzhou, Guangdong Province, China
Phone: +86 20 8888 9999
Email: [email protected]
Unified Social Credit Code: 91440106MA5XXXXX1Y
License No: GZ-OPT-2023-0045
Issued By (Optometrist Provider)
Dr. Li Wei, OD
Senior Clinical Optometrist
Guangzhou Vision Care Optometry Center
Specializing in Pediatric Vision Therapy and Advanced Contact Lens Fitting
Registered with the Guangdong Provincial Health Commission
Bill To (Client Information)
Mr. Zhang Jian
ID Number: 44010619850101XXXX
Address: 88 Huanshi East Road, Yuexiu District, Guangzhou, China
Phone: +86 138 0000 1234
Insurance Provider: Ping An Health Insurance Co., Ltd.
| # | Description of Optometric Services | Quantity | Unit Price (CNY) | Total (CNY) | Tax (6%) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Includes visual acuity testing, refraction, ocular health assessment, and intraocular pressure measurement. Performed by licensed Optometrist Dr. Li Wei at our Guangzhou clinic. |
1 | 350.00 | 350.00 | 21.00 |
| 2 |
Digital Retinal Imaging High-resolution fundus photography to assess the retina, optic nerve, and macula. Essential for early detection of diabetic retinopathy and glaucoma in China Guangzhou patients. |
1 | 200.00 | 200.00 | 12.00 |
| 3 |
Corneal Topography Mapping Advanced mapping of the corneal surface curvature. Required for custom contact lens fitting and pre-operative screening. |
1 | 400.00 | 400.00 | 24.00 |
| 4 |
Prescription Eyeglasses Dispensing Includes Zeiss single-vision lenses with anti-reflective coating and a premium titanium frame. Dispensed by our Guangzhou optical department. |
1 | 1,200.00 | 1,200.00 | 72.00 |
| 5 |
Orthokeratology (Ortho-K) Consultation Specialized consultation for overnight lens wear to correct myopia. Includes fitting assessment and follow-up schedule planning. |
1 | 500.00 | 500.00 | 30.00 |
| 6 |
Vision Therapy Session One-hour session focusing on binocular vision coordination and convergence insufficiency treatment. |
2 | 300.00 | 600.00 | 36.00 |
| Subtotal: | 3,250.00 CNY |
| Value Added Tax (6%): | 195.00 CNY |
| Discount (Member Loyalty): | -100.00 CNY |
| Grand Total Due: | 3,345.00 CNY |
Payment Terms and Conditions
Payment is due within 14 days of the invoice date. Please make payments via bank transfer to the account listed below or use WeChat Pay/Alipay at our Guangzhou clinic.
Bank Details:
Bank Name: Industrial and Commercial Bank of China (ICBC), Guangzhou Branch
Account Name: Guangzhou Vision Care Optometry Center Co., Ltd.
Account Number: 4000 1234 5678 9012 345
SWIFT Code: ICBKCNBJ
Optometrist Disclaimer:
This invoice covers professional services provided by a licensed Optometrist in China Guangzhou. It does not constitute a medical diagnosis of systemic diseases unless specified. All prescriptions are valid for one year from the date of issue. Please retain this invoice for insurance reimbursement purposes.
Privacy Notice:
In compliance with the Personal Information Protection Law of the People's Republic of China, your personal and health data will be kept confidential and used solely for the purpose of providing optometric care and billing.
Return Policy:
Eyewear products are eligible for exchange within 7 days if there is a manufacturing defect or prescription error. Services such as eye examinations and vision therapy are non-refundable once performed.
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