Invoice Orthodontist in Iraq Baghdad –Free Word Template Download with AI
Dr. Ahmed Al-Mansouri, DDS, MS Orthodontics
Al-Karrada District, Street 14, Building 42
Baghdad, Iraq
Tel: +964 770 123 4567 | Email: [email protected]
VAT Registration No: IQ-99887766
Invoice #: INV-2023-0892
Date: October 24, 2023
Due Date: November 24, 2023
Payment Status: Pending
Bill To:Mr. Karim Hassan
Al-Mansour District, Street 33
Baghdad, Iraq
Phone: +964 780 987 6543
Patient ID: PAT-4451
Description of Orthodontic ServicesThis invoice represents the professional fees for orthodontic treatment rendered at our clinic in Baghdad, Iraq. The services include comprehensive diagnosis, treatment planning, and the application of fixed orthodontic appliances designed to correct malocclusion and improve dental alignment. All prices are listed in Iraqi Dinar (IQD).
| # | Description of Service | Date | Qty | Unit Price (IQD) | Total (IQD) |
|---|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnosis Includes panoramic X-ray, cephalometric analysis, and digital impressions for treatment planning. |
Oct 01, 2023 | 1 | 75,000 | 75,000 |
| 2 |
Comprehensive Fixed Appliance Therapy (Braces) Placement of metal brackets and archwires on upper and lower arches. Includes all adjustment visits for 18 months. |
Oct 10, 2023 | 1 | 1,500,000 | 1,500,000 |
| 3 |
Interproximal Reduction (IPR) Minor enamel reshaping to create space for alignment. |
Oct 10, 2023 | 1 | 150,000 | 150,000 |
| 4 |
Orthodontic Elastics & Accessories Provision of rubber bands and power chains for bite correction. |
Oct 15, 2023 | 1 | 50,000 | 50,000 |
| 5 |
Emergency Adjustment Visit Repair of broken bracket and wire trimming. |
Oct 20, 2023 | 1 | 100,000 | 100,000 |
1. Currency: All amounts are payable in Iraqi Dinar (IQD). Cash, bank transfer, or major credit cards are accepted.
2. Due Date: Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest fee.
3. Bank Transfer Details:
Bank: Rafidain Bank, Baghdad Branch
Account Name: Baghdad Elite Orthodontics Co.
Account Number: 1234567890123456
4. Orthodontic Treatment Policy: This invoice covers the initial phase of treatment. Future retainers or post-treatment adjustments may be billed separately.
5. Contact: For any discrepancies regarding this invoice, please contact our billing department in Baghdad immediately.
Authorized Signature (Clinic)
Dr. Ahmed Al-Mansouri
Lead Orthodontist
Patient Signature (Acknowledgement)
Mr. Karim Hassan
Date: _______________
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