Invoice Orthodontist in India Mumbai –Free Word Template Download with AI
405, Horizon Tower, Bandra Kurla Complex
Bandra East, Mumbai, Maharashtra 400051
India Mumbai
Phone: +91 22 6789 1234
Email: [email protected]
GSTIN: 27AABCU9603R1ZM
INVOICE
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: October 30, 2024
Payment Status: Pending
Bill To (Patient/Guardian)
Name: Mr. Arjun Deshmukh
Patient Name: Ms. Priya Deshmukh (Age: 16)
Address: Flat 12B, Green Valley Apartments,
Linking Road, Bandra West,
Mumbai, Maharashtra 400050
India Mumbai
Phone: +91 98765 43210
Email: [email protected]
Treatment Plan: Comprehensive Fixed Orthodontic Treatment
Start Date: September 10, 2024
Estimated Duration: 18-24 Months
Consulting Orthodontist: Dr. Sneha Kapoor, MDS (Orthodontics)
Clinic Location: Mumbai Smile Orthodontics, India Mumbai
| # | Description of Orthodontic Service | Qty | Unit Price (INR) | Amount (INR) | GST (18%) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation and Diagnostic Records (X-rays, Photographs, Impressions) | 1 | 3,500.00 | 3,500.00 | 630.00 |
| 2 | Comprehensive Treatment Planning by Senior Orthodontist in Mumbai | 1 | 5,000.00 | 5,000.00 | 900.00 |
| 3 | Placement of Fixed Metal Brackets (Full Arch - Upper and Lower) | 1 | 45,000.00 | 45,000.00 | 8,100.00 |
| 4 | Orthodontic Archwires and Ligatures (Initial Set) | 1 | 8,000.00 | 8,000.00 | 1,440.00 |
| 5 | Monthly Adjustment and Monitoring Visits (First 3 Months) | 3 | 2,500.00 | 7,500.00 | 1,350.00 |
| 6 | Interproximal Reduction (IPR) Procedure | 1 | 4,000.00 | 4,000.00 | 720.00 |
| 7 | Orthodontic Elastics and Accessories | 1 | 1,500.00 | 1,500.00 | 270.00 |
| 8 | Emergency Orthodontic Visit (Bracket Repair) | 1 | 1,000.00 | 1,000.00 | 180.00 |
Please make the payment within 15 days from the date of this invoice. Payments can be made via the following methods:
- Bank Transfer: HDFC Bank, Bandra Branch, Mumbai, India Mumbai. Account Name: Mumbai Smile Orthodontics Pvt. Ltd., Account Number: 50200012345678, IFSC: HDFC0001234
- UPI: mumbaismileortho@hdfcbank
- Credit/Debit Card: Accepted at our clinic in India Mumbai
- Cheque: Payable to "Mumbai Smile Orthodontics"
Note: Please mention the Invoice Number (INV-2024-0892) in the payment remarks.
Terms and Conditions- This invoice is issued by Mumbai Smile Orthodontics, a registered orthodontic clinic in India Mumbai, in accordance with the Goods and Services Tax (GST) Act, 2017.
- All orthodontic treatments are subject to the clinical judgment of the treating Orthodontist. Treatment duration and costs may vary based on individual patient needs.
- Payment is due within 15 days of the invoice date. Late payments may incur a penalty of 2% per month on the outstanding amount.
- Regular follow-up appointments are essential for successful orthodontic treatment. Missed appointments may affect treatment progress and additional charges may apply.
- This invoice covers the services rendered up to the date of issue. Future adjustments and retainers will be billed separately as per the treatment plan.
- Any disputes related to this invoice should be raised within 7 days of receipt. The jurisdiction for any legal matters shall be the courts in Mumbai, India Mumbai.
- Patients are advised to maintain good oral hygiene during orthodontic treatment to avoid complications and additional costs.
Authorized Signatory
Dr. Sneha KapoorMDS (Orthodontics)
Patient/Guardian Acknowledgment
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