Invoice Orthodontist in China Guangzhou –Free Word Template Download with AI
Address: Room 1205, Zhujiang New Town Center, Tianhe District, Guangzhou, Guangdong, China
Phone: +86 20 8888 9999
Email: [email protected]
Unified Social Credit Code: 91440106MA5XXXXX1Y
License No: GZ-ORTH-2023-0045
Invoice Number: INV-GZ-2023-10-0042
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Period: September 2023 - October 2023
Bill To
Patient Name: Mr. Wei Zhang
Address: Flat 302, Building 5, Haizhu District, Guangzhou, China
ID Number: 4401061990XXXXXXXX
Phone: +86 138 0000 1234
Insurance / Third Party (If Applicable)
Provider: Ping An Health Insurance Co., Ltd.
Policy Number: PA-GZ-99887766
Group ID: GZ-CORP-001
| # | Description of Orthodontic Services | Date | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray, cephalometric analysis, and digital smile design assessment. This initial phase is critical for determining the severity of malocclusion and planning the treatment trajectory within our Guangzhou clinic. |
2023-09-05 | ¥ 800.00 | ¥ 800.00 |
| 2 |
Custom Clear Aligner Fabrication (Phase 1) Production of the first set of 10 custom-molded clear aligners using advanced CAD/CAM technology. These aligners are designed to correct mild crowding in the anterior region. |
2023-09-12 | ¥ 4,500.00 | ¥ 4,500.00 |
| 3 |
Interproximal Reduction (IPR) Minimal enamel stripping procedure performed to create necessary space for tooth movement. This is a standard procedure in modern orthodontics to ensure proper alignment without extraction. |
2023-09-12 | ¥ 600.00 | ¥ 600.00 |
| 4 |
Monthly Progress Monitoring & Adjustment Clinical evaluation of tooth movement progress, oral hygiene check, and issuance of the next set of aligners. This ensures the treatment plan remains on track according to the digital simulation. |
2023-10-10 | ¥ 500.00 | ¥ 500.00 |
| 5 |
Emergency Orthodontic Repair Adjustment of a loose attachment and replacement of a cracked aligner due to accidental damage. This service ensures continuity of care and prevents regression of tooth position. |
2023-10-18 | ¥ 300.00 | ¥ 300.00 |
Payment Terms and Conditions
Payment is due within 14 days of the invoice date. Please include the invoice number (INV-GZ-2023-10-0042) as the reference for all payments. Payments can be made via bank transfer, WeChat Pay, or Alipay. For bank transfers, please contact our finance department for account details.
Bank Details:
Bank Name: Industrial and Commercial Bank of China (ICBC), Guangzhou Branch
Account Name: Guangzhou Pearl River Orthodontics Co., Ltd.
Account Number: 4000 1234 5678 9012 3456
Orthodontic Treatment Notes
This invoice covers services rendered at our Guangzhou facility. Please note that orthodontic treatment is a long-term process. Regular attendance at scheduled appointments is crucial for the success of the treatment. Failure to attend appointments may result in additional fees or extension of the treatment timeline. Patients are responsible for maintaining their aligners and attachments. Damage due to negligence may incur replacement costs.
Legal Disclaimer
This document is a valid tax invoice issued in accordance with the tax regulations of the People's Republic of China. Any disputes regarding this invoice should be resolved through negotiation. If negotiation fails, the dispute shall be submitted to the People's Court in Tianhe District, Guangzhou.
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