Invoice Orthodontist in Bangladesh Dhaka –Free Word Template Download with AI
Specialized Orthodontic Care in Bangladesh
House #42, Road #11, Gulshan-2
Dhaka 1212, Bangladesh
Phone: +880 2 881 2345 | Mobile: +880 1711 555 666
Email: [email protected]
TIN: 123456789012 | BIN: 987654321
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Patient InformationName: Mr. Rahim Ahmed
Address: Flat #304, Bashundhara R/A, Block C, Dhaka 1229, Bangladesh
Phone: +880 1911 222 333
Email: [email protected]
NID Number: 1234567890
Treatment DetailsTreatment Plan: Comprehensive Fixed Orthodontic Therapy
Attending Orthodontist: Dr. Fatema Begum, BDS, MDS (Orthodontics)
Start Date: September 15, 2023
Estimated Duration: 18-24 Months
Case ID: CASE-OB-445
Description of Services and MaterialsThis invoice covers the initial consultation, diagnostic records, and the placement of fixed orthodontic appliances as per the treatment plan agreed upon in Dhaka. All services are rendered in accordance with the standards of the Bangladesh Dental Association.
| # | Description of Service / Item | Quantity | Unit Price (BDT) | Total (BDT) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Examination Comprehensive clinical evaluation of malocclusion and facial aesthetics. |
1 | 2,500.00 | 2,500.00 |
| 2 | Diagnostic Records Package Includes OPG X-Ray, Lateral Cephalogram, and Intraoral Photographs. |
1 | 3,000.00 | 3,000.00 |
| 3 | Study Models & Analysis Creation of plaster models for treatment planning and cephalometric analysis. |
1 | 1,500.00 | 1,500.00 |
| 4 | Pre-Orthodontic Scaling & Polishing Professional cleaning to ensure oral hygiene before appliance placement. |
1 | 1,200.00 | 1,200.00 |
| 5 | Fixed Orthodontic Appliance (Metal Braces) Premium quality stainless steel brackets for upper and lower arches. |
1 Set | 35,000.00 | 35,000.00 |
| 6 | Appliance Bonding & Placement Fee Professional fee for the Orthodontist to bond brackets and insert archwires. |
1 | 10,000.00 | 10,000.00 |
| 7 | Orthodontic Elastics & Accessories Initial supply of intermaxillary elastics and ligature ties. |
1 | 1,500.00 | 1,500.00 |
| 8 | First Month Adjustment Visit Follow-up appointment to activate wires and check adaptation. |
1 | 2,000.00 | 2,000.00 |
Amount in words: Fifty-Seven Thousand Thirty-Five Taka Only.
Payment Methods & Bank DetailsPlease make your payment via one of the following methods accepted in Bangladesh:
- Bank Transfer: Dutch-Bangla Bank Ltd., Gulshan Branch. Account Name: Dhaka Smile Orthodontics Ltd. Account No: 0123456789012.
- bKash/Nagad: Corporate Number: 01711555666 (Please send transaction ID).
- Cash/Card: Accepted at the clinic reception in Dhaka.
- Payment Terms: The total amount is due within 14 days of the invoice date. Late payments may incur a penalty of 2% per month.
- Treatment Plan: This invoice represents the initial phase of the orthodontic treatment. Future adjustment visits will be billed monthly as per the agreed schedule.
- Missed Appointments: Please provide at least 24 hours' notice for cancellations. Missed appointments without notice may be charged at half the consultation fee.
- Appliance Care: The patient is responsible for maintaining the orthodontic appliances. Damage due to negligence (e.g., eating hard foods) will be charged separately for repair.
- Validity: This invoice is valid for 30 days from the date of issue.
- Disputes: Any discrepancies regarding this invoice should be reported to the clinic administration in Dhaka within 7 days.
- Privacy: Patient information is kept confidential in accordance with the Digital Security Act of Bangladesh.
Thank you for choosing Dhaka Smile Orthodontics for your dental care needs. We are committed to providing the highest standard of orthodontic treatment in Bangladesh.
Authorized Signature
Dr. Fatema BegumLead Orthodontist
Dhaka Smile Orthodontics
Patient Acknowledgement
Mr. Rahim AhmedDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
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