Invoice Orthodontist in Iran Tehran –Free Word Template Download with AI

Specialized Orthodontic Center
No. 42, Valiasr Street, Near Shariati Square
Tehran, Iran
Postal Code: 19697-54321
Phone: +98 21 2200 5566
Email: [email protected]
Tax ID (Shenaseh Melli): 10102345678

Invoice Number: INV-TH-2023-0892
Date of Issue: October 15, 2023
Due Date: October 30, 2023
Payment Status: Pending

Bill To:

Patient Name: Mr. Reza Ahmadi
Address: No. 15, Enghelab Street, District 12
Tehran, Iran
Phone: +98 912 345 6789
National ID: 0012345678

Description of Orthodontic Services

This invoice represents the professional fees for comprehensive orthodontic treatment provided at our clinic in Tehran, Iran. The treatment plan was designed to correct malocclusion, align dental arches, and improve overall oral health and aesthetics. All procedures comply with the standards set by the Iranian Dental Association and local health regulations.

Item #	Description of Service	Quantity	Unit Price (IRR)	Total Price (IRR)
1	Initial Orthodontic Consultation and Diagnostic Records (X-rays, Photos, Impressions)	1	3,500,000	3,500,000
2	Custom Fabrication of Metal Braces (Full Arch)	1	25,000,000	25,000,000
3	Bracket Bonding and Archwire Placement	1	8,000,000	8,000,000
4	Monthly Adjustment and Progress Monitoring (First 3 Months)	3	2,000,000	6,000,000
5	Orthodontic Elastics and Ligatures (Supply Pack)	2	500,000	1,000,000
6	Emergency Visit for Bracket Repair	1	1,500,000	1,500,000
7	Post-Treatment Retainer Fabrication (Hawley Type)	1	4,500,000	4,500,000

Subtotal: 49,500,000 IRR Value Added Tax (VAT) 9%: 4,455,000 IRR Total Amount Due: 53,955,000 IRR Payment Terms and Methods

Payment is due within 15 days of the invoice date. Late payments may incur a penalty fee as per Iranian commercial law. Payments can be made via bank transfer to our account at Bank Melli Iran, branch Valiasr, Tehran. Account Number: 1234-5678-9012-3456. Please include the invoice number in the transfer reference. Cash payments are also accepted at our clinic in Tehran.

Additional Notes

This invoice is valid for tax purposes in Iran. Please retain this document for your records. If you have any questions regarding the charges or the orthodontic treatment plan, please contact our billing department. We are committed to providing high-quality orthodontic care in Tehran and ensuring transparency in all financial transactions.

Authorized Signature
Dr. Aria Farzaneh
Lead Orthodontist Patient Acknowledgment
Signature: __________________
Date: __________________ ⬇️ Download as DOCX Edit online as DOCX

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