Invoice Orthodontist in France Lyon –Free Word Template Download with AI
15 Rue de la République
69002 Lyon, France
Tel: +33 4 72 00 00 00
Email: [email protected]
SIRET: 123 456 789 00012
TVA Intracommunautaire: FR 12 123456789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Reference: LYON-ORTHO-2023
Billed By (Orthodontist)
Dr. Jean-Pierre Dubois
Lyon Orthodontic Center
15 Rue de la République
69002 Lyon, France
Specialist in Orthodontics and Dentofacial Orthopedics
Billed To (Patient)
Mme. Sophie Martin
42 Avenue Jean Jaurès
69007 Lyon, France
Sécurité Sociale N°: 1 85 02 69 000 123 45
Mutuelle: Groupama Santé Lyon
Description of Orthodontic Services Rendered in Lyon, France:
| Item | Description of Service | Base Fee (SS) | Professional Fee | Amount (EUR) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnosis Comprehensive clinical examination, panoramic radiograph, cephalometric analysis, and study models. This initial assessment is crucial for determining the appropriate orthodontic treatment plan tailored to the patient's specific dental alignment needs within the Lyon healthcare framework. |
€40.00 | €120.00 | €120.00 |
| 2 |
Fixed Orthodontic Appliance (Braces) - Upper Arch Placement of self-ligating brackets and archwires on the maxillary arch. Includes bonding procedure, adjustment, and initial activation. This procedure is performed according to the French National Health Insurance (Assurance Maladie) guidelines for orthodontic care. |
€150.00 | €450.00 | €450.00 |
| 3 |
Fixed Orthodontic Appliance (Braces) - Lower Arch Placement of self-ligating brackets and archwires on the mandibular arch. Includes bonding procedure, adjustment, and initial activation. Ensures comprehensive correction of malocclusion and alignment. |
€150.00 | €450.00 | €450.00 |
| 4 |
Monthly Orthodontic Adjustment Visit Routine check-up, wire adjustment, and progress monitoring. This visit ensures the orthodontic treatment is progressing as planned and addresses any patient concerns regarding comfort or appliance function. |
€25.00 | €80.00 | €80.00 |
| 5 |
Intermaxillary Elastics (Rubber Bands) Supply and instruction for use of elastic bands to correct bite alignment. Essential for achieving proper occlusion between upper and lower teeth during the active phase of orthodontic treatment. |
€10.00 | €30.00 | €30.00 |
| 6 |
Emergency Orthodontic Visit Unscheduled visit to address a broken bracket or poking wire. Prompt attention ensures treatment continuity and patient comfort, reflecting the high standard of orthodontic care provided in Lyon. |
€20.00 | €60.00 | €60.00 |
Payment Instructions & Orthodontic Care Notes
Payment Methods: This invoice may be settled via bank transfer (virement), check payable to "Dr. Jean-Pierre Dubois," or by credit card (Visa, Mastercard) at our Lyon clinic. Please include the invoice number as the payment reference.
Insurance Reimbursement: As per French regulations, orthodontic treatments are partially covered by the Assurance Maladie. The base fees listed are eligible for reimbursement. Patients with complementary health insurance (Mutuelle) may receive additional coverage. Please submit this invoice along with your "Feuille de Soins" to your insurer.
Orthodontic Treatment Plan: This invoice covers the initial phase of your orthodontic treatment. Regular monthly adjustments are essential for optimal results. Failure to attend scheduled appointments may prolong treatment duration and affect the final outcome.
Location: All services were rendered at our clinic located in Lyon, France. Our team is dedicated to providing world-class orthodontic care in a comfortable and professional environment.
This invoice is issued in accordance with French commercial law and the regulations governing orthodontic practice in France. The fees charged reflect the professional expertise and time invested in providing high-quality orthodontic care. Late payments may incur interest charges as per legal provisions. For any questions regarding this invoice or your orthodontic treatment, please contact our office in Lyon. Thank you for choosing Lyon Orthodontic Center for your dental health needs.
Disclaimer: This document is a sample invoice for illustrative purposes only. Actual invoices may vary based on specific treatment plans, insurance agreements, and current French healthcare regulations.
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