Invoice Orthodontist in Pakistan Karachi –Free Word Template Download with AI
Specialized Orthodontic Care Center
Plot #45-B, Clifton Block 5
Shahrah-e-Faisal, Karachi, Sindh
Pakistan - 75600
Phone: +92-21-3587-XXXX
Email: [email protected]
NTN: 1234567-8 | STRN: 1234567890123
Invoice Number: INV-2024-0892
Date of Issue: October 24, 2024
Due Date: November 07, 2024
Payment Status: Pending
Billed To:
Patient Name: Ahmed Khan
Guardian Name: Mr. Farhan Khan
Address: House #12, Street 7, DHA Phase 6
Karachi, Sindh, Pakistan
Phone: +92-300-1234567
CMH/Patient ID: ESO-8821
Treatment Details:
Attending Orthodontist: Dr. Sara Ali, FCPS (Orthodontics)
Treatment Plan: Comprehensive Fixed Appliance Therapy
Diagnosis: Class II Malocclusion with Crowding
Start Date: September 15, 2024
Estimated Duration: 18-24 Months
| # | Description of Orthodontic Services | Quantity | Unit Price (PKR) | Total (PKR) |
|---|---|---|---|---|
| 1 |
Initial Consultation & Diagnostic Records Includes panoramic X-ray, cephalometric analysis, study models, and clinical examination by senior orthodontist in Karachi. |
1 | 15,000 | 15,000 |
| 2 |
Comprehensive Orthodontic Treatment Plan Detailed treatment planning, risk assessment, and digital smile simulation. |
1 | 5,000 | 5,000 |
| 3 |
Fixed Appliance Placement (Metal Brackets) Premium self-ligating brackets for upper and lower arches, including bonding and archwire insertion. |
1 | 120,000 | 120,000 |
| 4 |
Monthly Adjustment Visits (First 3 Months) Regular orthodontic adjustments, wire changes, and progress monitoring. |
3 | 3,500 | 10,500 |
| 5 |
Orthodontic Elastics & Accessories Intermaxillary elastics, power chains, and ligatures for active treatment phase. |
1 | 5,000 | 5,000 |
| 6 |
Emergency Repair Visit Repair of dislodged bracket on lower left canine (Incurred on Oct 10, 2024). |
1 | 2,500 | 2,500 |
| 7 |
Professional Oral Hygiene Instruction Specialized cleaning techniques for orthodontic patients with fixed appliances. |
1 | 2,000 | 2,000 |
| Subtotal: | PKR 159,500 |
| Discount (Early Payment): | PKR (5,000) |
| SDPT (Sales Tax 18%): | PKR 27,510 |
| Grand Total: | PKR 182,010 |
Payment Terms & Important Information:
- This invoice is issued by Elite Smile Orthodontics, a registered orthodontic practice in Karachi, Pakistan.
- Payment is due within 14 days of the invoice date. Late payments may incur a 2% monthly interest charge.
- Accepted payment methods: Bank Transfer (HBL, UBL, MCB), JazzCash, EasyPaisa, and Credit/Debit Cards.
- Bank Details: HBL Account Title: Elite Smile Orthodontics, Account No: 0123-4567890-12-3, IBAN: PK36HABB0012345678901234.
- SDPT (Sales Development Payment Tax) is charged as per the regulations of the Federal Board of Revenue, Pakistan.
- Please retain this invoice for your records and for any insurance claims with TPL, AIG, or other health insurance providers in Pakistan.
- Orthodontic treatment requires regular follow-up visits. Missed appointments may affect treatment progress and additional charges may apply.
- For any queries regarding this invoice, please contact our billing department at +92-21-3587-XXXX or visit our clinic in Clifton, Karachi.
Authorized By:
Dr. Sara AliLead Orthodontist
Elite Smile Orthodontics
Received By:
Patient/Guardian SignatureDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
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