Invoice Orthodontist in China Shanghai –Free Word Template Download with AI
Specialized Dental & Orthodontic Care Center
Room 1205, Pudong Finance Plaza, Lujiazui
Pudong New Area, Shanghai, China 200120
Tel: +86 21 5888 9999 | Email: [email protected]
Unified Social Credit Code: 91310115MA1K3XXXXX
Official Tax Invoice
Bill To
Mr. Alexander Chen
1888 Century Avenue, Tower B, Apt 2401
Pudong District, Shanghai, China 200122
ID/Passport No: E12345678
Phone: +86 138 0000 1234
| # | Description of Orthodontic Services | Qty | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray, cephalometric analysis, and digital intraoral scanning. Assessment of malocclusion severity and treatment feasibility. |
1 | 800.00 | 800.00 |
| 2 |
Phase 1: Pre-Treatment Preparation Includes professional prophylaxis, extraction of supernumerary teeth (if required), and placement of temporary anchorage devices (TADs) for complex alignment. |
1 | 2,500.00 | 2,500.00 |
| 3 |
Custom Clear Aligner Therapy (Invisalign®/Angelalign®) Full series of custom-molded transparent aligners designed for the Shanghai Elite Orthodontics digital workflow. Includes 3D treatment simulation and monthly progress monitoring. |
1 | 35,000.00 | 35,000.00 |
| 4 |
Interproximal Reduction (IPR) Minimal enamel stripping to create space for optimal tooth movement and alignment. Performed under local anesthesia with precision diamond strips. |
1 | 1,200.00 | 1,200.00 |
| 5 |
Monthly Adjustment & Monitoring Visits Regular check-ups to ensure proper aligner fit, track tooth movement, and adjust treatment plan as necessary. Includes hygiene checks. |
12 | 500.00 | 6,000.00 |
| 6 |
Phase 2: Retention & Stabilization Includes fabrication of custom Essix retainers and/or bonded lingual retainers to maintain the new occlusion post-treatment. |
1 | 3,000.00 | 3,000.00 |
Terms, Conditions, and Payment Information
1. Payment Methods: We accept UnionPay, Alipay, WeChat Pay, and international credit cards (Visa/Mastercard). Bank transfers are also accepted for corporate accounts.
2. Due Date: Payment is due within 14 days of the invoice date. Late payments may incur a 1.5% monthly interest charge.
3. Treatment Commitment: This invoice covers the full scope of orthodontic treatment as outlined in the signed treatment plan. Any additional procedures not listed herein will be invoiced separately upon patient approval.
4. Retainer Policy: Replacement of retainers due to loss or damage after the initial 6-month warranty period will be charged at cost.
5. Cancellation Policy: Appointments must be cancelled at least 24 hours in advance. Failure to do so may result in a cancellation fee of 300 CNY.
6. Tax Compliance: This invoice complies with the tax regulations of the People's Republic of China. A formal Fapiao (official tax receipt) will be issued upon full payment.
7. Privacy: Your personal and medical information is protected under the Personal Information Protection Law (PIPL) of China.
Authorized Signature (Provider)
Dr. Li Wei, Chief Orthodontist
Shanghai Elite Orthodontics
Received By (Patient)
Signature: _________________________
Date: _________________________
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