Invoice Orthodontist in France Marseille –Free Word Template Download with AI
12 Avenue du Prado
13008 Marseille, France
Tel: +33 4 91 00 00 00
Email: [email protected]
INVOICE
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Billed To (Patient)
Sophie Dubois
45 Rue Paradis
13001 Marseille, France
SSN (NIR): 1 85 04 13 001 123 45
Insurance: Mutuelle Santé Plus
Provider Details
Dr. Laurent Moreau
Ordre des Dentistes: 13-00-1234
SIRET: 823 456 789 00012
TVA Intracommunautaire: FR 12 823456789
RPPS: 100041300012345
| Code | Description of Orthodontic Services | Base Fee | Tax | Total |
|---|---|---|---|---|
| 80.1 | Initial Orthodontic Consultation and Diagnostic Assessment in Marseille Clinic | €75.00 | €0.00 | €75.00 |
| 80.2 | Comprehensive Cephalometric and Panoramic X-Ray Analysis | €120.00 | €0.00 | €120.00 |
| 80.3 | Impressions and Study Models for Treatment Planning | €85.00 | €0.00 | €85.00 |
| 80.4 | Placement of Fixed Orthodontic Brackets (Metal) - Upper Arch | €450.00 | €0.00 | €450.00 |
| 80.5 | Placement of Fixed Orthodontic Brackets (Metal) - Lower Arch | €450.00 | €0.00 | €450.00 |
| 80.6 | Custom Archwire Fitting and Adjustment Session #1 | €150.00 | €0.00 | €150.00 |
| 80.7 | Intermaxillary Elastics and Retainer Fabrication | €200.00 | €0.00 | €200.00 |
Important Information Regarding This Invoice
This document serves as an official Invoice for orthodontic services rendered by Dr. Laurent Moreau, a certified Orthodontist practicing in France Marseille. The fees listed above reflect the standard rates for specialized dental care in the Provence-Alpes-Côte d'Azur region.
Payment Instructions: Payment is expected within 30 days of the invoice date. You may pay via bank transfer to our account at Crédit Agricole Provence (IBAN: FR76 1234 5678 9012 3456 7890 123) or by credit card in our Marseille clinic. Please reference the invoice number INV-2023-10-045 when making your payment.
Insurance and Reimbursement: As per French healthcare regulations, a portion of these costs may be covered by the Assurance Maladie and your complementary Mutuelle. We have provided an estimated reimbursement amount. Please submit this invoice to your insurance provider for final processing.
Orthodontic Treatment Plan: This invoice covers the initial phase of your orthodontic treatment. Regular follow-up appointments are required to ensure the proper alignment of your teeth. Failure to attend scheduled appointments may result in additional fees or delays in treatment progress.
Legal Compliance: This invoice complies with the fiscal laws of France. All services were performed at our clinic located in Marseille. For any questions regarding this invoice or your orthodontic treatment, please contact our administrative team directly.
Authorized Signature
Dr. Laurent MoreauOrthodontist ⬇️ Download as DOCX Edit online as DOCX
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