Invoice Orthodontist in Ghana Accra –Free Word Template Download with AI
Specialist Orthodontist & Dental Care
15 Independence Avenue, Ridge
Accra, Greater Accra Region
Ghana
Tel: +233 30 277 8899
Email: [email protected]
TIN: GH-9988776655
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Status: PENDING
Bill To:
Mr. Kwame Mensah
42 Osu Oxford Street
Osu, Accra
Ghana
Phone: +233 24 555 1234
Email: [email protected]
| Description of Orthodontic Services | Code | Qty | Unit Price (GHS) | Total (GHS) |
|---|---|---|---|---|
|
Initial Comprehensive Orthodontic Consultation Includes clinical examination, panoramic X-ray analysis, and treatment planning discussion at our Accra clinic. |
ORT-001 | 1 | 450.00 | 450.00 |
|
Diagnostic Records & Cephalometric Analysis Digital impressions, study models, and lateral cephalogram required for precise alignment planning. |
ORT-005 | 1 | 800.00 | 800.00 |
|
Fixed Metal Braces Placement (Full Arch) Supply and bonding of high-grade stainless steel brackets and archwires for upper and lower arches. |
ORT-102 | 1 | 4,500.00 | 4,500.00 |
|
Intermaxillary Elastics & Auxiliaries Provision of rubber bands and power chains to correct bite discrepancies during the active phase. |
ORT-110 | 1 | 350.00 | 350.00 |
|
Monthly Adjustment & Monitoring Visit Standard adjustment appointment to tighten wires and monitor tooth movement progress. |
ORT-200 | 1 | 300.00 | 300.00 |
|
Emergency Appointment (Bracket Repair) Urgent repair of dislodged bracket on the lower left canine. |
ORT-305 | 1 | 250.00 | 250.00 |
Payment Instructions
Please make payment within 14 days of the invoice date to avoid service interruption.
Bank Transfer (Ghana):
Bank Name: Ecobank Ghana Ltd
Branch: Ridge Branch, Accra
Account Name: Accra Elite Orthodontics Ltd
Account Number: 1002345678901
Mobile Money (MoMo):
Network: MTN Ghana
Number: 024 123 4567
Please reference Invoice #INV-2023-10-045 in your payment description.
Terms and Conditions
1. Validity: This invoice is valid for 30 days from the date of issue. Prices are subject to change after this period.
2. Payment: Payment is due within 14 days. Late payments may incur a penalty fee of 2% per month.
3. Orthodontic Treatment: Treatment duration is estimated based on current progress. Additional visits or materials may be required, which will be billed separately.
4. Missed Appointments: A fee of GHS 150.00 applies for missed appointments without 24-hour notice.
5. Disputes: Any discrepancies regarding this invoice must be reported within 7 days of receipt.
6. Jurisdiction: This agreement is governed by the laws of Ghana. Any disputes will be resolved in the courts of Accra.
7. Confidentiality: All patient records and financial information are kept strictly confidential in accordance with Ghanaian data protection regulations.
8. Thank You: Thank you for choosing Accra Elite Orthodontics for your dental care needs. We are committed to providing the highest standard of orthodontic treatment in Ghana.
Authorized Signature
Dr. Ama Osei
Lead Orthodontist
Accra Elite Orthodontics
Received By
__________________________
Date: ____________________
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