Invoice Optometrist in Netherlands Amsterdam –Free Word Template Download with AI
Professional Optometrist Services
Kalverstraat 92, 1012 PH Amsterdam
The Netherlands
KVK: 34567890 | BTW: NL856789012B01
Email: [email protected]
Phone: +31 20 123 4567
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 7, 2023
Service Location: Amsterdam, Netherlands
Bill To
Jan de Vries
Herengracht 450
1017 CA Amsterdam
The Netherlands
BSN: 123456789
Service Details
Appointment Date: October 20, 2023
Optometrist: Dr. Sarah Jansen, PhD
License Number: BIG-987654321
Insurance Provider: Zilveren Kruis
Policy Number: ZK-8877665544
| # | Description of Optometry Services | Quantity | Unit Price (EUR) | Total (EUR) | BTW % |
|---|---|---|---|---|---|
| 1 | Comprehensive Eye Examination (Volledig oogonderzoek) including refraction, visual acuity testing, and ocular health assessment performed by licensed Optometrist in Amsterdam. | 1 | 85.00 | 85.00 | 21% |
| 2 | Dilated Fundus Examination (Oogbodemonderzoek) to assess retina, optic nerve, and macula health. Essential for early detection of glaucoma and diabetic retinopathy. | 1 | 45.00 | 45.00 | 21% |
| 3 | Binocular Vision Assessment and Stereopsis Testing to evaluate eye coordination and depth perception capabilities. | 1 | 35.00 | 35.00 | 21% |
| 4 | Premium Anti-Reflective Coated Lenses (Progressive Multifocal) - High Index 1.67 material for optimal clarity and reduced thickness. | 1 | 220.00 | 220.00 | 21% |
| 5 | Designer Titanium Eyeglass Frame - Lightweight, hypoallergenic, and durable construction suitable for daily wear in Amsterdam climate. | 1 | 180.00 | 180.00 | 21% |
| 6 | Professional Lens Fitting and Frame Adjustment Service to ensure optimal comfort and visual alignment. | 1 | 25.00 | 25.00 | 21% |
| 7 | Dry Eye Syndrome Consultation and Treatment Plan including artificial tear prescription and lifestyle recommendations. | 1 | 40.00 | 40.00 | 21% |
| 8 | Prescription Documentation and Official Optometrist Report for insurance submission and medical records. | 1 | 15.00 | 15.00 | 21% |
| Subtotal (Excl. BTW): | € 645.00 |
| BTW (21%): | € 135.45 |
| Insurance Coverage (Zilveren Kruis): | - € 150.00 |
| Total Amount Due: | € 630.45 |
Please transfer the total amount due within 14 days to the following bank account:
Bank: ING Bank N.V., Amsterdam
Account Holder: Amsterdam Vision Care B.V.
IBAN: NL91 INGB 0001 2345 67
BIC/SWIFT: INGBNL2A
Reference: INV-2023-10-045
Note: Please include the invoice number as payment reference to ensure proper allocation.
Terms and Conditions
1. Payment is due within 14 days from the date of this invoice. Late payments may incur a statutory interest rate of 8% per annum as per Dutch law.
2. All optometry services provided by our licensed Optometrist in Amsterdam are subject to our professional standards and guidelines set by the Dutch Association of Optometrists.
3. Insurance claims have been processed directly with Zilveren Kruis. Any remaining balance is the responsibility of the patient.
4. Eyeglass frames and lenses are subject to a 14-day return policy if unused and in original packaging, in accordance with Dutch consumer protection laws.
5. This invoice serves as an official receipt for tax purposes in the Netherlands. Please retain this document for your records.
6. For any questions regarding this invoice or our optometry services, please contact our billing department at [email protected] or call +31 20 123 4567.
7. All prices are inclusive of applicable taxes unless otherwise stated. Exchange rates for international payments are subject to bank fees.
8. Our Optometrist reserves the right to refer patients to specialized ophthalmologists in Amsterdam if conditions require advanced medical intervention beyond optometric scope.
Amsterdam Vision Care B.V. is a registered healthcare provider in the Netherlands, specializing in comprehensive optometry services. Our licensed Optometrists are registered with the BIG-register and adhere to the highest standards of professional practice. This invoice document complies with Dutch fiscal regulations and EU invoicing standards. All services rendered at our Amsterdam location are covered under our professional liability insurance. For legal matters, this invoice is subject to the jurisdiction of the District Court of Amsterdam, Netherlands. We thank you for choosing our professional optometry services and trust that our care has contributed positively to your visual health and quality of life.
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