Invoice Orthodontist in Israel Jerusalem –Free Word Template Download with AI
Dr. Sarah Cohen, DDS, MSc
12 King George Street, Jerusalem, Israel 94250
Phone: +972-2-555-0199
Email: [email protected]
VAT ID: 512345678
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Payment Status: Pending
Bill To:
Mr. David Levy
45 Rehov HaYehudim, Jerusalem, Israel 94150
ID Number: 012345678
Phone: +972-50-123-4567
Email: [email protected]
Service Description: Comprehensive Orthodontic Treatment
This invoice details the professional orthodontic services rendered by Jerusalem Elite Orthodontics. As a premier orthodontist practice located in the heart of Israel Jerusalem, we are dedicated to providing world-class dental alignment and jaw correction services. The following charges reflect the initial consultation, diagnostic imaging, and the commencement of fixed appliance therapy as agreed upon in the treatment plan dated October 10, 2023.
| Item Description | Code | Qty | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|
| Initial Orthodontic Consultation & Clinical Examination | ORT-001 | 1 | 450.00 | 450.00 |
| Diagnostic Imaging: Panoramic X-Ray & Cephalometric Analysis | ORT-002 | 1 | 600.00 | 600.00 |
| Dental Impressions & Digital Scan for Treatment Planning | ORT-003 | 1 | 350.00 | 350.00 |
| Customized Treatment Plan Formulation | ORT-004 | 1 | 500.00 | 500.00 |
| Placement of Fixed Orthodontic Brackets (Metal) - Full Arch | ORT-010 | 1 | 3,500.00 | 3,500.00 |
| Archwire Insertion & Initial Adjustment | ORT-011 | 1 | 800.00 | 800.00 |
| Patient Education & Oral Hygiene Instructions | ORT-099 | 1 | 200.00 | 200.00 |
Payment Instructions
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer or credit card.
Bank Name: Bank Hapoalim
Branch: Jerusalem Central
Account Name: Jerusalem Elite Orthodontics Ltd.
Account Number: 999-888-777
SWIFT Code: POALILIT
Please reference Invoice Number INV-2023-10-045 with your payment.
Terms and Conditions
1. Validity: This invoice is valid for 30 days from the date of issue. Late payments may incur a monthly interest charge of 1.5% as per Israeli law.
2. Services: All orthodontic services are performed by licensed professionals adhering to the standards set by the Israel Dental Association.
3. Appointments: Please schedule your next adjustment appointment at least two weeks in advance. Cancellations must be made 24 hours prior to avoid a fee.
4. Insurance: If you have dental insurance, please submit this invoice directly to your provider. We can provide additional documentation if required.
5. Location: Our clinic is centrally located in Jerusalem, Israel, ensuring convenient access for all our patients in the region.
6. Disputes: Any discrepancies regarding this invoice should be reported within 7 days of receipt.
Thank you for choosing Jerusalem Elite Orthodontics for your dental care needs. We look forward to helping you achieve a healthy, beautiful smile.
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