Invoice Orthodontist in Algeria Algiers –Free Word Template Download with AI
Dr. Amine Benali, D.D.S., M.S. Orthodontics
12 Rue Didouche Mourad, Hydra
16000 Algiers, Algeria
Tel: +213 (0) 21 60 12 34
Email: [email protected]
NIF: 000123456789012 | NIS: 000123456789012
Official Medical Receipt
Bill To:
Patient Name: Karim & Fatima Zohra Hadjadj
Address: 45 Boulevard Mohamed V, Bab Ezzouar
City: Algiers, Algeria
Phone: +213 (0) 555 12 34 56
Insurance: CNAS / CASNOS (If applicable)
Orthodontic Treatment Services Rendered
The following invoice details the professional orthodontic services provided at our clinic in Algiers. This document serves as a formal record of the financial transaction for the correction of malocclusion and alignment of dental arches. All prices are listed in Algerian Dinars (DZD) and are inclusive of professional fees.
| Description of Service | Code | Qty | Unit Price (DZD) | Total (DZD) |
|---|---|---|---|---|
| Initial Orthodontic Consultation & Diagnosis Includes panoramic X-ray, cephalometric analysis, and digital impressions. |
ORT-001 | 1 | 8,000 | 8,000 |
| Comprehensive Fixed Appliance Therapy (Braces) Placement of high-quality stainless steel brackets on maxillary and mandibular arches. |
ORT-105 | 1 | 180,000 | 180,000 |
| Archwire Adjustments & Progress Monitoring Monthly adjustment sessions to ensure proper tooth movement and alignment. |
ORT-200 | 2 | 5,000 | 10,000 |
| Intermaxillary Elastics (Rubber Bands) Supplies for bite correction and jaw alignment. |
ORT-305 | 1 | 3,000 | 3,000 |
| Emergency Repair Service Replacement of dislodged bracket during treatment phase. |
ORT-400 | 1 | 4,000 | 4,000 |
Payment Information
Amount Paid: 238,950 DZD
Payment Method: Cash / CIB Card
Balance Due: 0.00 DZD
Thank you for choosing Algiers Elite Orthodontics for your dental health needs.
Terms and Conditions
- Currency: All amounts are quoted in Algerian Dinars (DZD).
- Payment Schedule: For comprehensive treatments, payments may be split into installments as agreed upon prior to the start of treatment.
- Appointments: Please arrive 10 minutes prior to your scheduled appointment at our Algiers clinic. Late cancellations (less than 24 hours notice) may incur a fee.
- Retention: Retainers are mandatory after the removal of braces to maintain the results of the orthodontic treatment.
- Validity: This invoice is valid for tax purposes in Algeria and can be used for insurance reimbursement claims.
Legal Notice: This document is an official invoice generated by Algiers Elite Orthodontics. It complies with the commercial and medical regulations of the People's Democratic Republic of Algeria. The services rendered are performed by licensed orthodontists registered with the Algerian Order of Dentists. In case of any discrepancy regarding the billing details, please contact our administrative office within 30 days of the invoice date. By accepting treatment, the patient acknowledges the risks and benefits associated with orthodontic procedures. This invoice serves as proof of payment and medical service delivery.
Authorized Signature: __________________________
Dr. Amine Benali
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