Invoice Orthodontist in Italy Rome –Free Word Template Download with AI
Dr. Alessandro Rossi, Specialist in Orthodontics
Via del Corso, 120
00186 Roma RM, Italy
P.IVA / C.F.: IT01234567890
Email: [email protected]
Phone: +39 06 1234 5678
Invoice Number: 2023-ORT-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Method: Bank Transfer / Satispay
Bill To:
Mr. Marco Bianchi
Via Nazionale, 45
00185 Roma RM, Italy
Codice Fiscale: BNCMRC80A01H501U
Email: [email protected]
| # | Description of Orthodontic Services | Quantity | Unit Price (€) | Total (€) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnostic Analysis Comprehensive clinical examination of the patient's dentition and occlusion. This includes the taking of panoramic radiographs (OPG), lateral cephalometric X-rays, and digital intraoral scans. Detailed analysis of skeletal and dental relationships to formulate a personalized treatment plan in accordance with Italian dental standards. |
1 | 150.00 | 150.00 |
| 2 |
Fixed Orthodontic Appliance Installation (Metal Brackets) Professional bonding of high-quality stainless steel brackets to the maxillary and mandibular arches. Includes the placement of the initial archwire and ligatures. This procedure marks the commencement of active orthodontic therapy to correct malocclusion and align teeth. |
1 | 1,200.00 | 1,200.00 |
| 3 |
Monthly Orthodontic Adjustment Session Routine follow-up appointment for the adjustment of archwires, replacement of ligatures, and monitoring of tooth movement. Includes oral hygiene instruction and assessment of treatment progress. This line item represents the first monthly adjustment fee. |
1 | 80.00 | 80.00 |
| 4 |
Intermaxillary Elastics & Auxiliaries Supply and fitting of elastic bands to correct bite discrepancies (Class II/III correction). Includes minor auxiliaries such as power chains or coil springs required to facilitate specific tooth movements during the active phase of treatment. |
1 | 45.00 | 45.00 |
| 5 |
Emergency Orthodontic Visit Unscheduled visit to address a broken bracket or poking wire. Includes repair of the appliance to ensure patient comfort and continuity of treatment without delay. |
1 | 50.00 | 50.00 |
| Subtotal: | € 1,525.00 |
| VAT (IVA 22%): | € 335.50 |
| TOTAL AMOUNT DUE: | € 1,860.50 |
Payment Instructions
Please transfer the total amount of € 1,860.50 to the following bank account:
Bank: Intesa Sanpaolo
IBAN: IT60 X030 6909 6061 0000 0012 345
BIC/SWIFT: BCITITMM
Reference: Invoice 2023-ORT-0892 - M. Bianchi
Payments can also be made via Satispay or credit card directly at the clinic in Rome.
Authorized Signature
Dr. Alessandro Rossi
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