Invoice Orthodontist in Ethiopia Addis Ababa –Free Word Template Download with AI
Specialized Orthodontist Services in Ethiopia
Bole Road, Near Friendship Hospital
Addis Ababa, Ethiopia
Tel: +251-11-661-2345
Email: [email protected]
TIN: 1002345678
Invoice Number: INV-2024-0892
Date Issued: January 15, 2024
Due Date: January 30, 2024
Payment Status: Pending
Bill To:
Patient Name: Abebe Kebede
Address: Kirkos Sub-City, Woreda 05, House No. 234
Addis Ababa, Ethiopia
Phone: +251-911-234-567
Email: [email protected]
Patient ID: ASOC-2024-0156
Payment Information
Bank Name: Commercial Bank of Ethiopia
Branch: Bole Branch, Addis Ababa
Account Name: Addis Smile Orthodontic Center
Account Number: 1000123456789
Currency: Ethiopian Birr (ETB)
Payment Methods Accepted: Bank Transfer, Telebirr, CBE Birr, Cash
| # | Description of Orthodontic Services | Date | Qty | Unit Price (ETB) | Amount (ETB) | Status |
|---|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation and Comprehensive Examination at Addis Smile Orthodontic Center, Addis Ababa | 2024-01-05 | 1 | 1,500.00 | 1,500.00 | Completed |
| 2 | Digital Panoramic X-Ray and Cephalometric Analysis for Orthodontic Treatment Planning | 2024-01-05 | 1 | 2,000.00 | 2,000.00 | Completed |
| 3 | Intraoral and Extraoral Photography for Orthodontic Records | 2024-01-05 | 1 | 1,000.00 | 1,000.00 | Completed |
| 4 | Dental Impressions and Study Models for Orthodontic Assessment | 2024-01-05 | 1 | 1,200.00 | 1,200.00 | Completed |
| 5 | Customized Orthodontic Treatment Plan Development by Specialist Orthodontist | 2024-01-08 | 1 | 2,500.00 | 2,500.00 | Completed |
| 6 | Professional Teeth Cleaning and Scaling Prior to Orthodontic Appliance Placement | 2024-01-10 | 1 | 1,800.00 | 1,800.00 | Completed |
| 7 | Placement of Fixed Metal Braces (Full Arch - Upper and Lower) by Certified Orthodontist | 2024-01-12 | 1 | 25,000.00 | 25,000.00 | Completed |
| 8 | Orthodontic Adjustment Appointment - First Month Follow-up | 2024-01-15 | 1 | 1,500.00 | 1,500.00 | Completed |
| 9 | Orthodontic Elastic Bands and Accessories Supply | 2024-01-12 | 3 | 500.00 | 1,500.00 | Completed |
| 10 | Emergency Orthodontic Visit - Bracket Repair Service | 2024-01-14 | 1 | 800.00 | 800.00 | Completed |
| Subtotal: | 38,800.00 | |||||
| VAT (15%): | 5,820.00 | |||||
| Total Amount Due: | 44,620.00 | |||||
Important Notes and Terms
1. This invoice is issued by Addis Smile Orthodontic Center, a licensed orthodontic practice located in Addis Ababa, Ethiopia, in accordance with Ethiopian tax regulations.
2. Payment is due within 15 days from the date of invoice issuance. Late payments may incur a penalty of 2% per month.
3. All orthodontic services rendered are performed by qualified orthodontists registered with the Ethiopian Medical Association.
4. Regular orthodontic adjustment appointments are essential for successful treatment outcomes. Please schedule your next appointment at least one week in advance.
5. Patients are advised to maintain excellent oral hygiene throughout their orthodontic treatment to prevent complications.
6. In case of any orthodontic emergencies, please contact our clinic immediately at +251-11-661-2345.
7. This invoice serves as an official receipt for tax and insurance purposes in Ethiopia.
8. For any questions regarding this invoice or your orthodontic treatment plan, please do not hesitate to contact our billing department.
Authorized by:
Dr. Selamawit Tadesse
Lead Orthodontist
Addis Smile Orthodontic Center
Addis Ababa, Ethiopia
Patient Acknowledgment:
Name: _________________________
Signature: _________________________
Date: _________________________
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