Invoice Orthodontist in Pakistan Islamabad –Free Word Template Download with AI
Dr. Sarah Ahmed, BDS, MDS (Orthodontics)
F-7/2, Markaz, Block F-7, Islamabad, Pakistan
National Tax Number (NTN): 1234567-8
Phone: +92 51 1234567 | Email: [email protected]
Member: Pakistan Dental Association (PDA)
Invoice No: INV-2023-0892
Date: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Patient Information| Billed To: |
Mr. Ahmed Khan House # 15, Street # 4, G-9/1, Islamabad, Pakistan CNIC: 35202-1234567-1 Phone: +92 300 1234567 |
This invoice covers the comprehensive orthodontic assessment and initial treatment phase for the correction of malocclusion (Class II Division 1) as prescribed by Dr. Sarah Ahmed. The treatment plan involves the use of fixed metal braces to align the dental arches and correct the bite relationship.
| # | Description of Service / Procedure | Qty | Unit Price (PKR) | Total (PKR) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnosis Includes clinical examination, study models, panoramic X-ray (OPG), and cephalometric analysis. |
1 | 5,000.00 | 5,000.00 |
| 2 |
Pre-Orthodontic Preparation Scaling and polishing, and necessary restorative work to prepare teeth for bracket placement. |
1 | 8,500.00 | 8,500.00 |
| 3 |
Fixed Orthodontic Appliances (Metal Braces) Supply and bonding of high-quality stainless steel brackets for full mouth (Upper and Lower arches). |
1 | 45,000.00 | 45,000.00 |
| 4 |
Archwires and Ligatures Initial set of nickel-titanium archwires and elastic ligatures for tooth movement. |
1 | 12,000.00 | 12,000.00 |
| 5 |
First Adjustment Visit Activation of appliances and initial force application. |
1 | 3,500.00 | 3,500.00 |
| Subtotal: | PKR 74,000.00 |
| Discount (Early Bird): | - PKR 4,000.00 |
| Grand Total: | PKR 70,000.00 |
Payment can be made via the following methods accepted in Islamabad:
- Cash: Accepted at the clinic reception.
- Bank Transfer: Meezan Bank, F-7 Branch, Islamabad. Account Title: Capital City Orthodontic Specialists. Account No: 0123456789012.
- Card: Visa/Mastercard accepted via JazzCash or EasyPaisa.
Terms and Conditions
- Validity: This invoice is valid for 15 days from the date of issue. Please ensure payment is made before the due date to avoid any interruption in treatment.
- Appointment Schedule: Regular adjustment appointments are scheduled every 4 to 6 weeks. Please maintain your schedule to ensure the orthodontic treatment progresses as planned.
- Emergency Care: In case of bracket breakage or wire poking, please contact the clinic immediately. Emergency visits may incur additional charges if not covered under the comprehensive package.
- Hygiene: Excellent oral hygiene is mandatory during orthodontic treatment. Failure to maintain hygiene may result in decalcification or gum disease, which could delay treatment.
- Retention: Retainers are not included in this invoice and will be provided at the end of the active treatment phase. Retainers are crucial for maintaining the new alignment of teeth.
- Refund Policy: Payments made for orthodontic appliances and services are non-refundable once the treatment has commenced.
- Compliance: This invoice complies with the tax regulations of Pakistan. A sales tax receipt will be issued upon request for corporate reimbursements.
Authorized Signature
Dr. Sarah Ahmed
Lead Orthodontist
Patient / Guardian Signature
Acknowledging receipt and agreement to terms.
Thank you for choosing Capital City Orthodontic Specialists in Islamabad, Pakistan.
Your smile is our priority.
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