Invoice Optometrist in Israel Jerusalem –Free Word Template Download with AI
Dr. Sarah Cohen, B.Optom, M.Sc.
12 King George Street, Jerusalem, 9425001, Israel
Phone: +972-2-625-1234 | Email: [email protected]
VAT ID: 512345678 | License No: OPT-JER-9988
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
Bill To:
Mr. David Levi
45 Nahalat Shiv'a, Jerusalem, 9415001, Israel
ID Number: 012-345678-9
Insurance Provider:
Clalit Health Services
Policy Number: CLT-99887766
Group Code: JER-EMP-001
Services and Products Rendered
| # | Description | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|
| 1 | Comprehensive Eye Examination (Adult) - Includes refraction, visual field test, and ocular health assessment. | 1 | 350.00 | 350.00 |
| 2 | Dilated Fundus Examination - Detailed inspection of the retina and optic nerve using mydriatic drops. | 1 | 150.00 | 150.00 |
| 3 | Prescription Eyeglasses - High-index polycarbonate lenses with anti-reflective and blue-light filtering coating. | 1 | 850.00 | 850.00 |
| 4 | Titanium Semi-Rimless Frame - Lightweight, durable frame selected for daily wear in Jerusalem climate. | 1 | 450.00 | 450.00 |
| 5 | Contact Lens Fitting and Evaluation - Includes trial lenses and follow-up assessment for astigmatism correction. | 1 | 200.00 | 200.00 |
| 6 | Box of Toric Soft Contact Lenses (6 lenses) - Monthly replacement schedule. | 2 | 180.00 | 360.00 |
| 7 | Eye Health Consultation - Discussion of diabetic retinopathy screening results and management plan. | 1 | 100.00 | 100.00 |
| Subtotal: | 2,460.00 ILS |
| Insurance Coverage (Clalit): | -1,200.00 ILS |
| Net Amount Before VAT: | 1,260.00 ILS |
| VAT (17%): | 214.20 ILS |
| Total Due: | 1,474.20 ILS |
Important Notes and Terms:
- This invoice is issued in accordance with the Israeli Value Added Tax Law, 1975.
- Payment is due within 30 days from the invoice date. Late payments may incur a 1.5% monthly interest charge.
- Insurance claims have been processed directly with Clalit Health Services. The remaining balance is the patient's responsibility.
- All optical products come with a 12-month warranty against manufacturing defects.
- For any questions regarding this invoice, please contact our billing department at +972-2-625-1234.
- This document serves as an official receipt for tax and insurance purposes in Israel.
Payment Methods:
Bank Transfer:
Bank: Bank Hapoalim
Branch: Jerusalem Central
Account Number: 998877665
Reference: INV-2023-10-045
Credit Card: Visa, Mastercard, and American Express accepted in-store.
Bit: Available for immediate payment via our secure online portal.
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