Invoice Orthodontist in Germany Frankfurt –Free Word Template Download with AI
Specialized Orthodontic Practice
Mainzer Landstraße 145
60327 Frankfurt am Main, Germany
Phone: +49 (0) 69 1234 5678
Email: [email protected]
VAT ID (USt-IdNr.): DE123456789
Invoice No: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
Reference: Patient ID #88291
Bill To:
Mr. Thomas Müller
Bockenheimer Landstraße 88
60325 Frankfurt am Main, Germany
Insurance Provider: TK (Techniker Krankenkasse)
Policy Number: TK-9988776655
| Description of Orthodontic Services | Code | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| Initial Orthodontic Consultation and Diagnostic Assessment in Frankfurt Clinic | GOZ #1 | 1 | 150.00 | 150.00 |
| Comprehensive Panoramic X-Ray and Cephalometric Analysis | GOZ #2 | 1 | 120.00 | 120.00 |
| Custom Impressions for Orthodontic Model Study | GOZ #3 | 1 | 85.00 | 85.00 |
| Application of Fixed Metal Brackets (Upper and Lower Arch) | GOZ #4 | 1 | 1,200.00 | 1,200.00 |
| Orthodontic Archwires and Ligatures (Initial Setup) | GOZ #5 | 1 | 250.00 | 250.00 |
| Monthly Adjustment and Progress Monitoring Visit | GOZ #6 | 1 | 110.00 | 110.00 |
| Emergency Repair of Dislodged Bracket | GOZ #7 | 1 | 75.00 | 75.00 |
| Professional Dental Cleaning Prior to Orthodontic Treatment | GOZ #8 | 1 | 95.00 | 95.00 |
Payment Instructions and Terms:
Please remit payment within 30 days of the invoice date to avoid late fees. Payments can be made via bank transfer to the following account:
Bank: Commerzbank AG Frankfurt
IBAN: DE89 5004 0000 0012 3456 78
BIC: COBADEFFXXX
Reference: INV-2023-10-045
Orthodontic Treatment Notes:
This invoice reflects services rendered at our specialized orthodontic practice in Frankfurt am Main. As per German dental regulations, certain orthodontic procedures may be partially covered by statutory health insurance if medical necessity is proven. Please ensure all relevant documentation is submitted to your insurance provider promptly. Any remaining balance is the responsibility of the patient.
Legal Disclaimer:
This document serves as an official invoice for orthodontic services provided in accordance with the German Fee Schedule for Dental Treatments (GOZ). All prices include applicable VAT as required by German tax law. For questions regarding this invoice or your orthodontic treatment plan, please contact our office in Frankfurt directly.
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