Invoice Orthodontist in Brazil Brasília –Free Word Template Download with AI
CNPJ: 12.345.678/0001-90
Address: SHIS QI 15, Conjunto 2, Casa 10, Lago Sul
Brasília - DF, Brazil, CEP: 71605-010
Phone: +55 (61) 3333-4444
Email: [email protected]
Invoice Number: #INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Method: Bank Transfer / PIX
Billed To:
Patient Name: Maria Clara Silva Santos
CPF: 123.456.789-00
Address: SIA Trecho 2, Lote 450, Asa Sul
Brasília - DF, Brazil, CEP: 71200-030
Phone: +55 (61) 99999-8888
Email: [email protected]
Services Rendered
The following invoice details the professional orthodontic services provided by a certified specialist in Brasília, Brazil. These procedures are part of a comprehensive treatment plan designed to correct malocclusion and improve dental alignment.
| Item | Description of Orthodontic Service | Quantity | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnosis Comprehensive clinical examination, panoramic radiography analysis, and cephalometric evaluation. This initial phase in Brasília includes the formulation of a personalized treatment strategy. |
1 | R$ 450.00 | R$ 450.00 |
| 2 |
Orthodontic Impressions & Digital Scanning Acquisition of precise dental models using state-of-the-art intraoral scanners. Essential for the fabrication of custom appliances and monitoring progress throughout the therapy. |
1 | R$ 300.00 | R$ 300.00 |
| 3 |
Placement of Fixed Orthodontic Appliances (Braces) Bonding of high-quality ceramic brackets to the maxillary and mandibular arches. Includes archwire insertion and ligation. This is a core procedure performed by the lead orthodontist. |
1 | R$ 3,500.00 | R$ 3,500.00 |
| 4 |
Periodic Adjustment & Monitoring Session Routine adjustment of archwires and elastic chains to ensure continuous tooth movement. Includes oral hygiene instruction and assessment of treatment progress in the Brasília clinic. |
4 | R$ 250.00 | R$ 1,000.00 |
| 5 |
Intermaxillary Elastics & Auxiliaries Supply of rubber bands and auxiliary springs required to correct bite discrepancies and align the dental midlines effectively during the active phase of treatment. |
1 | R$ 150.00 | R$ 150.00 |
| 6 |
Emergency Orthodontic Visit Unscheduled visit to address a loose bracket and wire irritation. Includes repair of the appliance to prevent treatment interruption and patient discomfort. |
1 | R$ 180.00 | R$ 180.00 |
| Subtotal: | R$ 5,580.00 |
| Discount (Early Payment): | - R$ 279.00 |
| Total Due: | R$ 5,301.00 |
Amount in words: Five thousand, three hundred and one Brazilian Reais.
Important Notes & Payment Instructions:
- Bank Details: Banco do Brasil, Agency: 1234-5, Account: 98765-4, PIX Key: [email protected].
- Validity: This invoice is valid for payment until the due date listed above. Late payments may incur interest as per Brazilian law.
- Receipt: Upon confirmation of payment, an official digital receipt (Recibo) will be emailed to the patient.
- Treatment Plan: This invoice covers specific phases of the orthodontic treatment. Future adjustments and retention phases will be invoiced separately.
- Location: All services were rendered at our primary clinic in Brasília, Federal District, Brazil.
Authorized by:
Dr. Ricardo Mendes
Lead Orthodontist
CRD-DF: 12345
Received by:
Maria Clara Silva Santos
Date: _______________
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