Invoice Orthodontist in New Zealand Auckland –Free Word Template Download with AI
Level 4, Sky Tower Medical Centre
Corner of Federal & Queen Streets
Auckland CBD, Auckland 1010
New Zealand
Phone: +64 9 309 5500 | Email: [email protected]
BNZ Account: 02-0101-01234567-00
Invoice Number: INV-AKL-2023-8942
Date Issued: 24 October 2023
Due Date: 07 November 2023
Reference: Patient File #8821-B
Bill To:
Mr. Jonathan & Mrs. Sarah Thompson
142 Remuera Road
Remuera
Auckland 1050
New Zealand
Email: [email protected]
Patient Details:
Patient Name: Emily Rose Thompson
Date of Birth: 12 May 2010
NHI Number: 1234567890
Treatment Plan: Comprehensive Fixed Appliance Therapy
Consulting Orthodontist: Dr. A. Patel, FRCR
| # | Description of Orthodontic Services | Code | Unit Price (NZD) | Total (NZD) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Assessment Includes panoramic radiograph, cephalometric analysis, and digital intra-oral scanning. This initial consultation in Auckland establishes the baseline for treatment planning. |
ORT-001 | $350.00 | $350.00 |
| 2 |
Fixed Appliance Placement (Braces) Supply and bonding of high-grade stainless steel brackets and archwires. Includes initial adjustment and patient education on oral hygiene specific to orthodontic appliances. |
ORT-105 | $4,500.00 | $4,500.00 |
| 3 |
Intermaxillary Elastics and Auxiliaries Provision of elastic bands and power chains required for bite correction during the active phase of treatment. |
ORT-202 | $250.00 | $250.00 |
| 4 |
Monthly Adjustment Visit (October 2023) Routine check-up, wire change, and progress monitoring. Ensures the treatment timeline remains on track according to the New Zealand Dental Council standards. |
ORT-301 | $150.00 | $150.00 |
| 5 |
Emergency Repair Service Re-bonding of loose molar band on the lower right quadrant. This service ensures patient comfort and prevents treatment delays. |
ORT-405 | $120.00 | $120.00 |
| 6 |
Retention Planning and Fabrication Design and creation of custom Hawley retainers to be used post-debonding. Essential for maintaining the corrected alignment in the Auckland climate and lifestyle. |
ORT-500 | $450.00 | $450.00 |
| Subtotal: | $5,820.00 |
| GST (15%): | $873.00 |
| Total Due (NZD): | $6,693.00 |
Payment Terms and Conditions
1. Payment Due Date: Payment is due within 14 days of the invoice date. Please ensure payment is made by 07 November 2023 to avoid any late fees.
2. Payment Methods: We accept bank transfers to our BNZ account, credit cards (Visa/Mastercard), and EFTPOS in our Auckland clinic. Please quote the Invoice Number (INV-AKL-2023-8942) as the reference for all payments.
3. GST Compliance: This invoice includes Goods and Services Tax (GST) at the current New Zealand rate of 15%. Our GST Registration Number is 123-456-789.
4. Insurance Claims: If you have private health insurance, please contact your provider directly. Auckland Elite Orthodontics can provide a detailed breakdown of codes if required by your insurer for reimbursement.
5. Disputes: If you have any questions regarding this invoice or the orthodontic services provided, please contact our billing department immediately at +64 9 309 5500.
6. Late Payments: Invoices not paid by the due date may incur a late fee of 1% per month on the outstanding balance, in accordance with New Zealand commercial law.
Authorized By:
Dr. A. Patel
Lead Orthodontist
Auckland Elite Orthodontics
Received By:
__________________________
Date: ____________________
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