Invoice Orthodontist in Australia Sydney –Free Word Template Download with AI
Level 12, 100 George Street
Sydney NSW 2000, Australia
Phone: +61 2 9123 4567
Email: [email protected]
ABN: 12 345 678 901
Provider Number: 987654321
From
Dr. Sarah Jenkins
Specialist Orthodontist
Australian Health Practitioner Regulation Agency (AHPRA) Reg: 123456
Bill To
Mr. James Anderson
42 Harbour View Road
Bondi Beach NSW 2026
Australia
Patient ID: PAT-5591
| Item | Description of Orthodontic Services | Item Number | Quantity | Amount (AUD) |
|---|---|---|---|---|
| 1 |
Comprehensive Orthodontic Consultation & Assessment Initial clinical examination, panoramic radiograph analysis, and formulation of a detailed treatment plan for malocclusion correction. Includes discussion of fixed appliance options versus clear aligner therapy suitable for the Sydney patient demographic. |
40010 | 1 | $350.00 |
| 2 |
Fixed Orthodontic Appliance Placement (Upper Arch) Bonding of stainless steel brackets and placement of archwire on the maxillary arch. This procedure is part of the comprehensive fixed appliance therapy to correct dental alignment and bite issues. |
40020 | 1 | $2,800.00 |
| 3 |
Fixed Orthodontic Appliance Placement (Lower Arch) Bonding of stainless steel brackets and placement of archwire on the mandibular arch. Essential for establishing proper occlusion and completing the full-mouth orthodontic correction. |
40021 | 1 | $2,800.00 |
| 4 |
Monthly Orthodontic Adjustment & Monitoring Routine adjustment of archwires, replacement of ligatures, and monitoring of tooth movement progress. This visit ensures the treatment plan remains on track and addresses any discomfort or appliance breakages. |
40030 | 1 | $250.00 |
| 5 |
Interproximal Reduction (IPR) Minimal enamel stripping between specific teeth to create necessary space for alignment, reducing the need for extractions. Performed under local anaesthesia for patient comfort. |
40045 | 1 | $150.00 |
| 6 |
Orthodontic Retainer Fabrication (Hawley) Custom fabrication of an acrylic and wire retainer for the upper arch to maintain tooth position post-treatment. Includes fitting and instructions on care and wear schedule. |
40060 | 1 | $450.00 |
Payment Instructions & Terms
Payment Due Date: Payment is due within 14 days of the invoice date. Late payments may incur interest charges in accordance with Australian commercial law.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
Account Name: Sydney Elite Orthodontics Pty Ltd
BSB: 062-000
Account Number: 1234 5678
Reference: INV-2023-8942
Health Insurance & Rebates:
Please note that orthodontic treatment is generally considered an elective procedure. While some private health insurance funds in Australia offer extras cover for orthodontics, Medicare typically does not provide rebates for cosmetic or standard orthodontic treatment unless it is deemed medically necessary due to severe functional impairment. We recommend contacting your fund directly to verify your specific coverage limits.
Privacy Policy:
Sydney Elite Orthodontics is committed to protecting your privacy in accordance with the Australian Privacy Principles (APPs). Your personal and health information will only be used for the purpose of providing orthodontic treatment and billing.
Queries:
If you have any questions regarding this invoice or your orthodontic treatment plan, please contact our billing department at +61 2 9123 4567 or email [email protected].
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