Invoice Orthodontist in Philippines Manila –Free Word Template Download with AI
Specialized Orthodontic Care in the Heart of the Philippines
Unit 405, Ayala Tower One, Makati Avenue
Makati City, Metro Manila, Philippines 1226
Tel: +63 (2) 8888-1234 | Email: [email protected]
TIN: 000-123-456-000 | BIR Accredited
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
Status: Unpaid
Bill To:
Mr. Roberto Santos
123 Rizal Street, Barangay San Antonio
Quezon City, Metro Manila, Philippines 1100
Contact: +63 917 123 4567
Email: [email protected]
Patient Details:
Patient Name: Maria Santos
Date of Birth: March 15, 2010
Case Number: MS-2023-089
Treatment Plan: Comprehensive Braces Alignment
Attending Orthodontist: Dr. Elena Cruz, DDS, MS Ortho
| Description of Orthodontic Services | Code | Qty | Unit Price (PHP) | Total (PHP) |
|---|---|---|---|---|
| Initial Consultation and Diagnostic Records (X-rays, Impressions) | ORTHO-001 | 1 | 5,000.00 | 5,000.00 |
| Comprehensive Orthodontic Treatment Plan Formulation | ORTHO-002 | 1 | 3,500.00 | 3,500.00 |
| Placement of Metal Brackets and Archwires (Full Mouth) | ORTHO-101 | 1 | 45,000.00 | 45,000.00 |
| Monthly Adjustment and Progress Monitoring (October 2023) | ORTHO-201 | 1 | 2,500.00 | 2,500.00 |
| Emergency Visit for Bracket Repair | ORTHO-301 | 1 | 1,500.00 | 1,500.00 |
| Professional Orthodontic Supplies and Materials | MAT-001 | 1 | 3,000.00 | 3,000.00 |
Important Notes Regarding Your Orthodontic Treatment in Manila:
This invoice represents the charges for orthodontic services rendered at our clinic in Metro Manila, Philippines. As per the treatment plan agreed upon with Dr. Elena Cruz, the total cost for the comprehensive braces treatment is PHP 150,000.00, payable in installments over the course of the treatment period, which is estimated to be 18 to 24 months.
Please note that all prices are in Philippine Pesos (PHP) and include the 12% Value Added Tax (VAT) as required by the Bureau of Internal Revenue (BIR) of the Philippines. Late payments may incur a penalty fee of 1.5% per month on the outstanding balance.
Regular monthly adjustments are crucial for the success of your orthodontic treatment. Please ensure that you schedule your next appointment at least two weeks in advance. Our clinic is located in Makati City, a central business district in Manila, and we offer convenient parking for our patients.
If you have any questions about this invoice or your treatment plan, please do not hesitate to contact our billing department. We are committed to providing the highest quality orthodontic care in the Philippines.
Payment Methods Accepted:
Bank Transfer:
BDO Unibank, Makati Branch
Account Name: Manila Smile Orthodontics Inc.
Account Number: 1234-5678-9012
SWIFT Code: BNORPHMM
Credit/Debit Cards: Visa, Mastercard, UnionPay
GCash/Maya: +63 917 888 9999
Cash: Accepted at our clinic office during business hours.
Authorized by:
Dr. Elena Cruz, DDS, MS OrthoLead Orthodontist
Received by:
Patient/Guardian SignatureDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
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