Invoice Optometrist in South Africa Johannesburg –Free Word Template Download with AI
Registered Optometrists in South Africa
123 Sandton Drive, Sandton City
Johannesburg, Gauteng, 2196
South Africa
Tel: +27 11 555 0123
Email: [email protected]
Reg No: 2023/123456/07
POPIA Compliant Practice
Invoice Number: INV-2024-0892
Date Issued: 15 October 2024
Due Date: 15 November 2024
Payment Terms: Net 30 Days
Reference: JOH-OPH-2024-0892
Bill To:
Mr. Thabo Mokoena
456 Rivonia Road
Rivonia, Johannesburg
Gauteng, 2128
South Africa
ID Number: 850101 5000 087
Medical Aid: Discovery Health
Member Number: DIS-987654321
Service Location:
ClearVision Optometrists Clinic
123 Sandton Drive, Sandton City
Johannesburg, Gauteng, 2196
South Africa
Optometrist: Dr. Sarah van der Merwe
Registration: OHP-2015-12345
Service Date: 10 October 2024
| # | Description of Optometry Services | Quantity | Unit Price (ZAR) | Amount (ZAR) | VAT (15%) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Full optometric assessment including visual acuity testing, refraction, binocular vision assessment, and ocular health evaluation conducted by registered Optometrist in Johannesburg. |
1 | R 850.00 | R 850.00 | R 127.50 |
| 2 |
Dilated Fundus Examination Specialized retinal examination using mydriatic drops to assess posterior segment health, including optic nerve and macula evaluation. |
1 | R 450.00 | R 450.00 | R 67.50 |
| 3 |
Prescription Spectacle Lenses (Premium Anti-Reflective) High-index progressive lenses with anti-reflective coating, scratch-resistant treatment, and UV protection. Manufactured to precise prescription specifications. |
1 | R 2,800.00 | R 2,800.00 | R 420.00 |
| 4 |
Titanium Spectacle Frame Premium lightweight titanium frame with adjustable nose pads and spring hinges. Includes professional fitting and adjustment by qualified Optometrist. |
1 | R 1,200.00 | R 1,200.00 | R 180.00 |
| 5 |
Computer Vision Syndrome Assessment Specialized evaluation for digital eye strain, including near vision testing, convergence assessment, and ergonomic recommendations for screen users in Johannesburg office environments. |
1 | R 350.00 | R 350.00 | R 52.50 |
| 6 |
Glaucoma Screening (Tonometry & Visual Field) Intraocular pressure measurement and automated perimetry testing for early detection of glaucoma, as recommended by South African Optometric Council guidelines. |
1 | R 550.00 | R 550.00 | R 82.50 |
| 7 |
Protective Eyewear Case & Cleaning Kit Hard-shell protective case, microfiber cleaning cloth, and lens cleaning solution for proper maintenance of prescription spectacles. |
1 | R 180.00 | R 180.00 | R 27.00 |
| Subtotal: | R 6,380.00 |
| VAT (15%): | R 957.00 |
| Medical Aid Contribution: | -R 3,200.00 |
| Amount Due (ZAR): | R 4,137.00 |
Payment Instructions:
Please remit payment within 30 days of the invoice date. Late payments may incur interest at 1.5% per month in accordance with South African credit practices.
Bank Details:
Bank: First National Bank (FNB)
Account Name: ClearVision Optometrists (Pty) Ltd
Account Number: 62045678901
Branch Code: 250655
Reference: INV-2024-0892
For electronic payments via EFT, please ensure the reference number is included to facilitate accurate allocation of your payment.
Terms and Conditions:
1. This Invoice is issued by ClearVision Optometrists, a registered practice operating in South Africa Johannesburg, in compliance with the Optometrists Act No. 43 of 1991 and regulations set by the Health Professions Council of South Africa (HPCSA).
2. All services rendered by our qualified Optometrist are subject to professional standards and ethical guidelines as prescribed by South African law. Our practice maintains full registration with the HPCSA and adheres to all statutory requirements for optometric care in Johannesburg.
3. Medical aid claims are submitted directly to your insurer. The contribution amount shown is an estimate based on your plan benefits. Any shortfall between the medical aid contribution and the total cost is the responsibility of the patient.
4. All prices are quoted in South African Rand (ZAR) and include applicable Value Added Tax (VAT) at the current rate of 15% as required by the South African Revenue Service (SARS).
5. Spectacle lenses and frames are custom-made to your specific prescription and cannot be returned or exchanged unless there is a manufacturing defect or error in dispensing. Please inspect your eyewear carefully upon collection.
6. Our Optometrist reserves the right to refer patients to an ophthalmologist if conditions beyond the scope of optometric practice are detected during examination.
7. Patient records are maintained in accordance with the Protection of Personal Information Act (POPIA) of South Africa. Your personal and medical information is treated with strict confidentiality.
8. This Invoice serves as an official receipt for tax purposes. Please retain this document for your records and for submission to your medical aid or insurance provider.
9. For any queries regarding this Invoice or the services provided by our Optometrist in South Africa Johannesburg, please contact our billing department at [email protected] or call +27 11 555 0123 during business hours (Monday to Friday, 08:00 - 17:00 SAST).
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