Invoice Orthodontist in Israel Tel Aviv –Free Word Template Download with AI
Dr. Sarah Cohen, DDS, MSc
12 Rothschild Boulevard, Tel Aviv-Yafo, Israel 6688101
Phone: +972-3-555-0199 | Email: [email protected]
VAT ID: 512345678
Official Tax Document
Bill To:
Mr. David Levi
45 Allenby Street
Tel Aviv-Yafo, Israel 6473903
ID Number: 001-234567-8
Orthodontic Treatment Services Rendered
This invoice details the professional orthodontic services provided in our Tel Aviv clinic. As a leading orthodontist in Israel, we are committed to providing transparent billing for all corrective dental procedures, including fixed appliances, clear aligners, and retention therapy.
| Description of Service | Code | Qty | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|
|
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray analysis, cephalometric evaluation, and digital smile design planning. This initial assessment is crucial for determining the correct treatment path for malocclusion. |
ORT-001 | 1 | 450.00 | 450.00 |
|
Fixed Metal Braces Installation (Full Arch) Placement of high-quality stainless steel brackets and archwires on both upper and lower jaws. This is the standard orthodontic treatment for complex alignment issues. |
ORT-105 | 1 | 6,500.00 | 6,500.00 |
|
Monthly Adjustment and Monitoring Visit Routine check-up to tighten archwires, replace ligatures, and monitor tooth movement progress. Essential for maintaining the timeline of the orthodontic treatment plan. |
ORT-200 | 3 | 350.00 | 1,050.00 |
|
Intermaxillary Elastics (Rubber Bands) Supply of prescription-grade elastic bands used to correct bite discrepancies (overbite/underbite) during the active phase of treatment. |
ORT-310 | 1 | 150.00 | 150.00 |
|
Emergency Orthodontic Repair Repair of a detached bracket and re-bonding procedure performed outside of scheduled appointments to prevent treatment delay. |
ORT-405 | 1 | 250.00 | 250.00 |
|
Digital Intraoral Scanning Advanced 3D scanning of the dental arches to update the treatment model and ensure precise alignment tracking. |
ORT-500 | 1 | 300.00 | 300.00 |
In accordance with the Israeli Tax Authority regulations, a VAT of 17% has been applied to the subtotal. This invoice serves as a valid tax document for reimbursement purposes with health maintenance organizations (HMOs) such as Clalit, Maccabi, Meuhedet, or Leumit, subject to your specific insurance coverage terms.
Payment Instructions & Terms
Please remit payment within 30 days of the invoice date to avoid late fees. We accept the following payment methods:
- Bank Transfer: Bank Hapoalim, Branch Tel Aviv Center, Account Number: 999-88-777766.
- Credit Card: Visa, MasterCard, and American Express accepted in-office or via secure online portal.
- Installment Plans: For comprehensive orthodontic treatments, we offer interest-free installment plans over 12 to 24 months. Please contact our billing department to arrange.
Orthodontic Treatment Disclaimer
This invoice reflects the current stage of your orthodontic journey. As your orthodontist in Tel Aviv, we emphasize that treatment duration varies by patient. Regular attendance at scheduled appointments is mandatory to ensure optimal results. Failure to attend appointments may result in additional charges or extension of the treatment period. Retainers must be worn as prescribed post-treatment to maintain alignment.
For any questions regarding this invoice or your treatment plan, please contact our office during business hours (Sunday-Thursday, 08:00-18:00). Thank you for trusting Tel Aviv Advanced Orthodontics with your smile.
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