Invoice Optometrist in Saudi Arabia Riyadh –Free Word Template Download with AI
Specialized Optometry & Ophthalmology Clinic
Address: Olaya District, King Fahd Road, Building 456
Riyadh, 12211, Saudi Arabia
Phone: +966 11 234 5678 | Email: [email protected]
ZATCA VAT Registration Number: 300123456789003
Invoice Number: INV-2023-10-0045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Al-Rajhi Medical Insurance Company
Attn: Claims Department
Address: King Abdulaziz Road, Al Malqa
Riyadh, 11564, Saudi Arabia
VAT Number: 310987654321003
Patient Details:
Name: Ahmed Mohammed Al-Saud
National ID / Iqama: 1098765432
Policy Number: ARC-99887766
Contact: +966 50 123 4567
| # | Description of Optometry Services | Quantity | Unit Price (SAR) | Total (SAR) | VAT (15%) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Includes visual acuity testing, refraction, and ocular health assessment performed by a licensed Optometrist in Riyadh. |
1 | 350.00 | 350.00 | 52.50 |
| 2 |
Dilated Fundus Examination Advanced retinal screening to detect early signs of diabetic retinopathy and glaucoma. |
1 | 200.00 | 200.00 | 30.00 |
| 3 |
Prescription Eyewear Dispensing High-index anti-reflective lenses with premium titanium frame. Includes fitting and adjustment. |
1 | 1,200.00 | 1,200.00 | 180.00 |
| 4 |
Orthokeratology Consultation Specialized assessment for overnight lens wear to correct myopia. |
1 | 450.00 | 450.00 | 67.50 |
| 5 |
Visual Field Test (Perimetry) Computerized mapping of peripheral vision. |
1 | 150.00 | 150.00 | 22.50 |
Terms, Conditions, and Regulatory Compliance
This invoice is issued in accordance with the regulations set forth by the Zakat, Tax and Customs Authority (ZATCA) in Saudi Arabia. All services listed above were provided by certified professionals at our Riyadh facility. The term "Optometrist" refers to the licensed healthcare provider responsible for the diagnosis and management of vision conditions as per the Saudi Commission for Health Specialties (SCFHS) standards.
Payment Instructions: Payments should be made via bank transfer to Al Rajhi Bank, Account Name: Riyadh Vision Care Center, IBAN: SA03 8000 0000 6080 1016 7519. Please reference the Invoice Number INV-2023-10-0045 in the transfer description.
Validity: This invoice is valid for 30 days from the date of issue. Late payments may incur a penalty as per Saudi commercial law.
Disclaimer: This document serves as a formal request for payment for optometric services rendered. It is not a medical prescription but a financial record. For medical queries, please contact our clinical team directly.
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