Invoice Orthodontist in Japan Tokyo –Free Word Template Download with AI
1-2-3 Shibuya, Shibuya-ku, Tokyo 150-0002, Japan
Tel: +81-3-1234-5678 | Email: [email protected]
Corporate Number: 1234567890123
Orthodontic Treatment Services
Billed To:Mr. John Doe
4-5-6 Roppongi, Minato-ku
Tokyo 106-0032, Japan
Insurance / Ref No: JH-2023-8899
| # | Description of Orthodontic Services | Date | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray analysis, cephalometric tracing, and digital smile design assessment. This initial evaluation is crucial for determining the severity of malocclusion and planning the specific treatment trajectory required for your unique dental structure. |
Oct 02 | ¥30,000 | ¥30,000 |
| 2 |
Custom Clear Aligner Fabrication (Phase 1) Production of the first set of custom-molded, medical-grade polyurethane aligners. These devices are engineered specifically for your dental arch to gradually shift teeth into the desired alignment without the use of traditional metal brackets. |
Oct 05 | ¥150,000 | ¥150,000 |
| 3 |
Interproximal Reduction (IPR) Procedure Minor enamel reshaping performed to create necessary space for tooth movement. This procedure is essential for preventing crowding during the orthodontic correction process and ensuring a stable, long-term result. |
Oct 10 | ¥25,000 | ¥25,000 |
| 4 |
Monthly Progress Monitoring & Adjustment Clinical examination to verify tooth movement progress against the digital treatment plan. Includes intraoral scanning to ensure the current aligners are fitting correctly and adjustments to the treatment timeline if necessary. |
Oct 20 | ¥15,000 | ¥15,000 |
| 5 |
Orthodontic Retainer (Upper & Lower) Fabrication of custom Essix retainers to be worn post-treatment. These retainers are vital for maintaining the new position of your teeth and preventing relapse, a standard requirement in all orthodontic cases in Japan. |
Oct 25 | ¥40,000 | ¥40,000 |
Payment Terms and Conditions
This invoice represents the charges for orthodontic services rendered at our clinic in Tokyo, Japan. Payment is due within 30 days of the invoice date. Late payments may incur a penalty fee of 1.5% per month.
Bank Transfer Details:
Bank Name: Mizuho Bank, Ltd.
Branch: Shibuya Branch
Account Type: Ordinary Account
Account Number: 1234567
Account Name: Shibuya Advanced Orthodontics Co., Ltd.
Important Notice:
Orthodontic treatment is a long-term commitment. Please ensure you attend all scheduled appointments to avoid delays in your treatment plan. If you have any questions regarding this invoice or your treatment progress, please contact our billing department immediately. We are committed to providing the highest standard of dental care in Japan.
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