Invoice Orthodontist in Nigeria Lagos –Free Word Template Download with AI
Dr. Adebayo Ogunlesi, MS Orthodontics
14 Admiralty Way, Lekki Phase 1
Lagos, Nigeria
Tel: +234 803 555 1234
Email: [email protected]
TIN: 12345678-0001
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Status: PENDING
Bill To:Mr. Chukwuemeka Obi
45 Victoria Island Avenue
Victoria Island, Lagos, Nigeria
Phone: +234 901 234 5678
Email: [email protected]
Orthodontic Services RenderedThe following invoice details the professional fees for comprehensive orthodontic treatment provided at our Lagos facility. This document serves as an official record of the financial transaction for the correction of malocclusion and alignment of dentition as per the treatment plan agreed upon during the initial consultation.
| Description of Service | Code | Qty | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|---|
|
Initial Comprehensive Orthodontic Consultation Includes clinical examination, study models, and panoramic radiographs. |
DOC-001 | 1 | 25,000.00 | 25,000.00 |
|
Full Mouth Debridement & Prophylaxis Pre-orthodontic cleaning to ensure optimal bonding environment. |
HYG-102 | 1 | 15,000.00 | 15,000.00 |
|
Placement of Fixed Metal Braces (Full Arch) Includes brackets, archwires, and bonding agents for both upper and lower jaws. |
ORT-505 | 1 | 450,000.00 | 450,000.00 |
|
Interproximal Reduction (IPR) Selective enamel stripping to create space for alignment. |
ORT-303 | 1 | 30,000.00 | 30,000.00 |
|
Monthly Adjustment Visit (October) Routine wire change and progress monitoring. |
ORT-601 | 1 | 15,000.00 | 15,000.00 |
|
Emergency Repair (Broken Bracket) Replacement of dislodged bracket on tooth #24. |
ORT-999 | 1 | 10,000.00 | 10,000.00 |
Please make payment within 14 days of the invoice date. Payments can be made via bank transfer to the following account:
- Bank Name: First Bank of Nigeria
- Account Name: Lagos Elite Orthodontics Ltd
- Account Number: 0123456789
- Reference: INV-2023-10-045
For mobile payments, please use the Paystack link provided in the accompanying email. Kindly send proof of payment to our billing department to update your records.
Terms and Conditions- Payment Terms: Payment is due within 14 days. Late payments may incur a penalty fee of 2% per month on the outstanding balance.
- Treatment Plan: This invoice covers specific services rendered as outlined above. Future orthodontic adjustments and retention fees will be billed separately according to the initial treatment agreement.
- Missed Appointments: Please note that missed appointments without 24-hour notice may result in a cancellation fee, which will be added to future invoices.
- Disputes: If you have any questions or disputes regarding this invoice, please contact our office within 7 days of receipt.
- Confidentiality: All patient information and billing details are kept strictly confidential in accordance with Nigerian data protection regulations.
- Validity: This invoice is valid for 30 days from the date of issue.
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