Invoice Orthodontist in India Bangalore –Free Word Template Download with AI
Dr. Arjun Mehta, MDS (Orthodontics)
Reg. No: KDC-12345 | GSTIN: 29ABCDE1234F1Z5
123, MG Road, Indiranagar
Bangalore, Karnataka - 560038
India
Phone: +91 80 1234 5678 | Email: [email protected]
Invoice No: INV-2023-0892
Date: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To:Patient Name: Priya Sharma
Address: 45, Koramangala 4th Block, Bangalore, Karnataka - 560034, India
Contact: +91 98765 43210
GSTIN (if applicable): Not Applicable (Individual Consumer)
Insurance Provider: Star Health & Allied Insurance Co. Ltd.
Policy Number: SH-987654321
Orthodontic Services Rendered| # | Description of Service | Code | Qty | Rate (INR) | Amount (INR) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Diagnostic Records (X-Rays, Impressions) | ORTHO-001 | 1 | 2,500.00 | 2,500.00 |
| 2 | Comprehensive Fixed Appliance Therapy (Metal Braces) - Upper & Lower Arch | ORTHO-010 | 1 | 45,000.00 | 45,000.00 |
| 3 | Extraction of Premolars (Tooth #44 & #34) for Alignment | EXT-005 | 2 | 1,500.00 | 3,000.00 |
| 4 | Monthly Adjustment & Progress Monitoring (First Month) | ORTHO-020 | 1 | 1,200.00 | 1,200.00 |
| 5 | Orthodontic Elastics & Accessories Kit | ACC-003 | 1 | 800.00 | 800.00 |
(Fifty-Nine Thousand Indian Rupees Only)
Payment Instructions
Please make the payment within 14 days of the invoice date to avoid any interruption in your orthodontic treatment plan.
- Bank Name: HDFC Bank
- Branch: Indiranagar, Bangalore
- Account Name: SmileCraft Orthodontics Pvt. Ltd.
- Account Number: 50100123456789
- IFSC Code: HDFC0001234
- UPI ID: smilecraftortho@hdfcbank
Note: Please mention the Invoice Number (INV-2023-0892) in the payment remarks.
Terms & Conditions
- This invoice is issued in accordance with the Goods and Services Tax (GST) Act, 2017, applicable in India.
- Payment is due within 14 days from the date of invoice. Late payments may attract a penalty of 2% per month.
- Orthodontic treatment duration is estimated at 18-24 months. Monthly adjustment fees are billed separately unless a package plan is opted.
- Any damage to braces due to negligence may incur additional repair charges.
- Insurance claims must be submitted within 30 days of treatment completion.
- For any discrepancies in this invoice, please contact our billing department at [email protected] within 7 days.
- This invoice is valid for tax deduction at source (TDS) if applicable under Indian Income Tax Laws.
Authorized Signatory
Dr. Arjun Mehta
Lead Orthodontist
Received By
Priya Sharma
Date: _______________
Thank you for choosing SmileCraft Orthodontics in Bangalore, India.
Your smile is our priority. For appointments, call +91 80 1234 5678.
This is a computer-generated invoice and does not require a physical signature.
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