Invoice Orthodontist in Brazil Rio de Janeiro –Free Word Template Download with AI
Dr. Ricardo Silva, CRO-RJ 45892
Av. Atlântica, 1702, Copacabana
Rio de Janeiro, RJ - 22021-001
Brazil
Phone: +55 (21) 3289-4500
Email: [email protected]
CNPJ: 12.345.678/0001-90
Professional Orthodontic Services
Bill To:
Ms. Ana Paula Costa
Rua Visconde de Pirajá, 550, Apt 42
Ipanema, Rio de Janeiro, RJ
CEP: 22410-002
CPF: 123.456.789-00
This invoice represents the professional fees for specialized orthodontic treatment provided in accordance with the standards of the Regional Council of Dentistry of Rio de Janeiro (CRO-RJ). The services listed below were performed at our clinic located in the heart of Rio de Janeiro, Brazil, utilizing advanced diagnostic imaging and customized treatment plans designed to correct malocclusion and improve dental aesthetics.
| # | Description of Orthodontic Services | Code (CBOS) | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation and Diagnosis: Comprehensive clinical examination, analysis of panoramic radiographs and cephalometric X-rays. Discussion of treatment options including fixed appliances and clear aligners. This initial assessment is crucial for establishing the baseline of the patient's dental health in Rio de Janeiro. |
3221-05 | R$ 350.00 | R$ 350.00 |
| 2 |
Placement of Fixed Orthodontic Appliances (Braces): Bonding of stainless steel brackets to the maxillary and mandibular arches. Includes isolation, etching, bonding agent application, and placement of the initial archwire. This procedure marks the beginning of the active phase of the orthodontic treatment. |
3221-10 | R$ 4,500.00 | R$ 4,500.00 |
| 3 |
First Monthly Adjustment and Activation: Routine adjustment of archwires to apply corrective forces. Evaluation of tooth movement progress and oral hygiene status. Replacement of elastic ligatures. This visit ensures the treatment plan is proceeding as scheduled. |
3221-15 | R$ 450.00 | R$ 450.00 |
| 4 |
Intermaxillary Elastics (Rubber Bands): Supply and instruction for the use of Class II elastics to correct bite alignment. These are essential for refining the occlusion between the upper and lower teeth during the orthodontic process. |
3221-20 | R$ 150.00 | R$ 150.00 |
| 5 |
Professional Prophylaxis (Cleaning): Removal of plaque and calculus around orthodontic brackets to prevent gingivitis and decalcification. Maintaining oral hygiene is critical for patients undergoing orthodontic treatment in Brazil. |
3221-25 | R$ 200.00 | R$ 200.00 |
Payment Instructions
Please make payment via bank transfer (TED/DOC) or PIX to the following account:
Bank: Banco do Brasil
Agency: 1234-5
Account: 98765-4
PIX Key: [email protected]
Reference: Invoice INV-2023-10-045
Important Notes & Terms
1. Validity: This invoice is valid for payment within 14 days from the date of issue. Late payments may incur interest charges as per Brazilian law.
2. Treatment Plan: The services listed are part of a comprehensive orthodontic treatment plan. Future adjustments and materials will be invoiced monthly or as per the agreed schedule.
3. Compliance: All procedures are performed in compliance with the ethical code of the Brazilian Dental Association (CFO) and the Regional Council of Dentistry of Rio de Janeiro (CRO-RJ).
4. Insurance: If you have dental insurance coverage for orthodontics, please submit this invoice along with the detailed clinical report to your provider. Rio Smile Orthodontics can assist with pre-authorization requests.
5. Missed Appointments: Please note that missed appointments without 24-hour notice may result in a cancellation fee, which will be added to the next invoice.
Thank you for choosing Rio Smile Orthodontics for your dental care in Rio de Janeiro, Brazil. We are committed to providing you with a beautiful, healthy smile through expert orthodontic care.
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