Invoice Orthodontist in New Zealand Wellington –Free Word Template Download with AI
Level 3, 123 Lambton Quay
Wellington Central, Wellington 6011
New Zealand
Phone: +64 4 555 0199
Email: [email protected]
BNZ: 02-0123-0456789-00
From
Dr. Sarah Jenkins, Orthodontist
Wellington Orthodontic Specialists
Registered with the Dental Council of New Zealand
Practicing in accordance with the Health and Disability Commissioner Code of Rights.
Bill To
Mr. James & Mrs. Emily Thompson
45 Oriental Parade
Thorndon, Wellington 6011
New Zealand
Phone: +64 21 555 1234
Email: [email protected]
This invoice represents the professional fees for orthodontic treatment provided at our Wellington clinic. As a leading provider of orthodontic care in New Zealand Wellington, we are committed to delivering high-quality dental alignment services. This statement covers the initial consultation, diagnostic imaging, and the commencement of fixed appliance therapy (braces) for patient Liam Thompson (DOB: 12/05/2010). All services listed below have been rendered in compliance with New Zealand dental standards and pricing guidelines.
| Description of Services | Date | Quantity | Amount (NZD) |
|---|---|---|---|
|
Initial Orthodontic Consultation & Examination Comprehensive assessment of dental occlusion, facial profile analysis, and discussion of treatment options suitable for the Wellington region. Includes review of medical history. |
01 Oct 2023 | 1 | $250.00 |
|
Diagnostic Imaging & Records Panoramic X-ray (OPG), Cephalometric X-ray, and intra-oral photography. Essential for creating a precise treatment plan for the patient's specific orthodontic needs. |
01 Oct 2023 | 1 | $180.00 |
|
Impressions & Study Models Taking of upper and lower dental impressions to create plaster study models for diagnostic wax-up and appliance fabrication. |
01 Oct 2023 | 1 | $120.00 |
|
Fixed Orthodontic Appliance Therapy (Braces) - Deposit Deposit towards the full course of fixed appliance treatment. This includes the supply and bonding of stainless steel brackets, archwires, and ligatures. This is a significant portion of the total orthodontic cost. |
15 Oct 2023 | 1 | $1,500.00 |
|
First Adjustment Appointment Initial fitting of archwires and activation of the orthodontic appliance. Includes patient education on oral hygiene maintenance specific to wearing braces. |
15 Oct 2023 | 1 | $150.00 |
|
Emergency Repair (Bracket Replacement) Replacement of a debonded lower left molar bracket due to accidental trauma. Included in the warranty of the appliance installation. |
20 Oct 2023 | 1 | $0.00 |
| Subtotal: | $2,200.00 |
| GST (15%): | $330.00 |
| Total Due (NZD): | $2,530.00 |
Payment Terms & Conditions
Payment Method: Please pay via bank transfer to the BNZ account listed in the header, or pay in person at our Wellington clinic using EFTPOS or Credit Card.
Due Date: Payment is due within 14 days of the invoice date. Late payments may incur a 5% administration fee in accordance with New Zealand trade credit practices.
GST: This invoice includes Goods and Services Tax (GST) at the current New Zealand rate of 15%. Our GST Registration Number is 123-456-789.
Orthodontic Treatment Plan: Please note that this invoice covers only the initial phase of treatment. The total estimated cost for the full course of orthodontic therapy is $4,500.00 NZD. A payment plan is available for the remaining balance, payable in monthly installments over the duration of the treatment.
Complaints Procedure: If you are dissatisfied with any aspect of the service provided by our Orthodontist, please contact our practice manager directly. We adhere to the Health and Disability Commissioner (Code of Health and Disability Services Consumers' Rights) Regulations 1996.
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