Invoice Orthodontist in Japan Kyoto –Free Word Template Download with AI
1-2-3 Shijo-Dori, Kawaramachi, Nakagyo-ku
Kyoto, Japan 604-8006
Tel: +81-75-123-4567 | Email: [email protected]
Corporate Number: 701000100123456
Official Payment Request
Bill To:
Mr. Hiroshi Tanaka
4-5-6 Gion-machi, Higashiyama-ku
Kyoto, Japan 605-0073
Phone: +81-90-9876-5432
Email: [email protected]
| # | Description of Orthodontic Services | Quantity | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray, cephalometric analysis, and digital intraoral scanning. This initial assessment is crucial for determining the specific alignment needs of the patient within our Kyoto clinic standards. |
1 | 15,000 | 15,000 |
| 2 |
Fixed Appliance Therapy (Metal Brackets) - Upper Arch Placement of high-quality stainless steel brackets and archwires. This procedure is performed by our lead orthodontist to ensure precise tooth movement and optimal occlusion. |
1 | 180,000 | 180,000 |
| 3 |
Fixed Appliance Therapy (Metal Brackets) - Lower Arch Placement of matching brackets and archwires on the mandibular arch. Coordinated with the upper arch treatment plan to achieve a balanced bite. |
1 | 180,000 | 180,000 |
| 4 |
Interproximal Reduction (IPR) Minimal enamel stripping to create necessary space for alignment. Performed with precision diamond strips to ensure safety and comfort during the orthodontic process. |
1 | 25,000 | 25,000 |
| 5 |
Monthly Adjustment and Progress Monitoring Routine check-up including wire changes, ligature replacement, and progress evaluation. Essential for maintaining the momentum of tooth movement. |
2 | 12,000 | 24,000 |
| 6 |
Emergency Repair Service Adjustment of loose bracket and replacement of broken archwire segment. This service ensures that treatment is not delayed due to appliance failure. |
1 | 8,000 | 8,000 |
| 7 |
Professional Orthodontic Cleaning Specialized cleaning around brackets and wires to prevent plaque buildup and gingivitis. Maintaining oral hygiene is critical during orthodontic treatment in Kyoto. |
1 | 10,000 | 10,000 |
Payment Terms and Conditions:
Payment is due within 30 days of the invoice date. Please make payments via bank transfer to the account details below. Late payments may incur a 1.5% monthly interest charge.
Bank Transfer Details:
Bank Name: Mizuho Bank, Kyoto Main Branch
Account Type: Ordinary Account
Account Number: 1234567
Account Name: Kyoto Precision Orthodontics Co., Ltd.
Important Notice:
This invoice covers orthodontic services provided at our clinic in Kyoto, Japan. Please retain this document for your records and for any potential insurance claims. If you have any questions regarding this invoice or your orthodontic treatment plan, please contact our billing department directly.
Thank you for choosing Kyoto Precision Orthodontics for your dental care needs. We are committed to providing the highest standard of orthodontic treatment in Japan.
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