Invoice Orthodontist in India New Delhi –Free Word Template Download with AI
Dr. Rajesh Kumar, MDS (Orthodontics)
Registered Orthodontist - Council of Dental Practitioners
42, Defence Colony, Block A
New Delhi, Delhi 110024, India
Phone: +91-11-4567-8901
Email: [email protected]
GSTIN: 07AABCS1234D1Z5
Invoice Number: INV-2024-0847
Date: January 15, 2024
Due Date: January 30, 2024
Payment Status: Pending
Bill To:
Patient Name: Priya Sharma
Address: 15, Green Park Extension, New Delhi, Delhi 110016, India
Phone: +91-98765-43210
Email: [email protected]
Patient ID: SC-ORTH-2024-0156
Treatment Plan: Comprehensive Orthodontic Correction with Ceramic Braces
| # | Description of Orthodontic Services | HSN Code | Qty | Unit Price (₹) | Amount (₹) | GST (18%) |
|---|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation and Diagnostic Assessment including panoramic X-ray and cephalometric analysis | 9933 | 1 | 2,500.00 | 2,500.00 | 450.00 |
| 2 | Comprehensive Orthodontic Treatment Plan Formulation and Digital Smile Design Consultation | 9933 | 1 | 3,000.00 | 3,000.00 | 540.00 |
| 3 | Professional Dental Impressions and Study Model Creation for Orthodontic Treatment Planning | 9933 | 1 | 1,800.00 | 1,800.00 | 324.00 |
| 4 | Ceramic Braces System (Upper and Lower Arch) - Premium Aesthetic Orthodontic Appliances | 9021 | 1 | 45,000.00 | 45,000.00 | 8,100.00 |
| 5 | Professional Braces Bonding Procedure - Complete Arch Placement by Certified Orthodontist | 9933 | 1 | 8,500.00 | 8,500.00 | 1,530.00 |
| 6 | Orthodontic Archwires (Stainless Steel and Nickel-Titanium) - Initial Treatment Phase | 9021 | 4 | 1,200.00 | 4,800.00 | 864.00 |
| 7 | Orthodontic Elastic Bands and Ligatures - Monthly Supply Package (3 Months) | 9021 | 3 | 800.00 | 2,400.00 | 432.00 |
| 8 | Interproximal Reduction (IPR) Procedure for Optimal Tooth Alignment and Space Management | 9933 | 1 | 3,500.00 | 3,500.00 | 630.00 |
| 9 | Orthodontic Adjustment and Progress Monitoring Visits (First 3 Months - 3 Sessions) | 9933 | 3 | 2,000.00 | 6,000.00 | 1,080.00 |
| 10 | Emergency Orthodontic Care Coverage - Wire Adjustment and Bracket Repair (If Required) | 9933 | 1 | 1,500.00 | 1,500.00 | 270.00 |
| Subtotal: | ₹78,000.00 |
| GST (18%): | ₹14,040.00 |
| Professional Fee Discount: | -₹5,000.00 |
| Grand Total: | ₹87,040.00 |
Amount in Words: Eighty-Seven Thousand Forty Rupees Only
Important Notes and Terms:
1. Treatment Duration: The comprehensive orthodontic treatment with ceramic braces typically requires 18-24 months. Regular adjustment appointments every 4-6 weeks are mandatory for optimal results.
2. Payment Terms: Payment is due within 15 days from the invoice date. We accept bank transfers, UPI, credit/debit cards, and cash payments at our New Delhi clinic.
3. GST Compliance: This invoice is issued in accordance with the Goods and Services Tax (GST) regulations of India. GSTIN is provided above for your records.
4. Orthodontic Care Instructions: Patients must maintain excellent oral hygiene throughout the treatment. Avoid hard, sticky, and chewy foods that may damage braces. Use orthodontic wax for any discomfort.
5. Emergency Services: In case of orthodontic emergencies such as broken brackets or protruding wires, contact our clinic immediately. Emergency appointments are prioritized for active treatment patients.
6. Retention Phase: Upon completion of active treatment, a retention phase with custom retainers will be required to maintain the corrected alignment. Retainer costs are separate and will be quoted accordingly.
7. Insurance: This invoice can be submitted to your dental insurance provider for reimbursement as per your policy coverage for orthodontic treatments in India.
8. Refund Policy: In case of treatment discontinuation, refund calculations will be based on services already rendered and materials utilized, as per our clinic's policy.
Authorized Signatory
Dr. Rajesh Kumar
Lead Orthodontist
SmileCraft Orthodontics
Patient Acknowledgment
Name: _________________
Signature: _________________
Date: _________________
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