Invoice Orthodontist in Qatar Doha –Free Word Template Download with AI
Specialized Orthodontic Care in Qatar
Al Waab Street, Building 45, Office 12
Doha, Qatar
P.O. Box: 23456
Phone: +974 4412 3456
Email: [email protected]
VAT Registration Number: 123456789000003
Ministry of Public Health License: MOPH-ORTH-2024-089
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: November 15, 2024
Payment Terms: Net 30 Days
Bill To:
Patient Name: Ahmed Al-Thani
Guardian (if applicable): Fatima Al-Thani
Address: Villa 78, Diplomatic Area, Zone 62
City: Doha, Qatar
Phone: +974 3345 6789
Email: [email protected]
National ID / Qatar ID: 2985XXXXXX
Insurance Provider: Bupa Qatar
Policy Number: BUPA-QA-789456
| # | Description of Orthodontic Services | Date of Service | Quantity | Unit Price (QAR) | Total (QAR) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Orthodontic Consultation and Diagnostic Assessment in Doha | 2024-09-01 | 1 | 350.00 | 350.00 |
| 2 | Full Series Digital Panoramic X-Ray and Cephalometric Analysis | 2024-09-01 | 1 | 450.00 | 450.00 |
| 3 | 3D Intraoral Scanning for Digital Treatment Planning | 2024-09-01 | 1 | 300.00 | 300.00 |
| 4 | Professional Dental Prophylaxis (Cleaning) Prior to Orthodontic Treatment | 2024-09-10 | 1 | 250.00 | 250.00 |
| 5 | Placement of Self-Ligating Fixed Orthodontic Braces (Full Arch - Upper and Lower) | 2024-09-15 | 1 | 8,500.00 | 8,500.00 |
| 6 | Custom Orthodontic Elastics and Interarch Wires | 2024-09-15 | 1 | 400.00 | 400.00 |
| 7 | First Orthodontic Adjustment and Progress Evaluation Appointment | 2024-10-10 | 1 | 350.00 | 350.00 |
| 8 | Emergency Orthodontic Repair (Loose Bracket Replacement) | 2024-10-12 | 1 | 200.00 | 200.00 |
Important Notes and Terms for Orthodontic Services in Qatar Doha:
1. This invoice represents the charges for orthodontic services rendered at Doha Elite Orthodontics Center, located in Doha, Qatar. All prices are quoted in Qatari Riyals (QAR).
2. Payment is due within 30 days from the date of invoice issuance. Late payments may incur a penalty of 2% per month as per Qatar commercial regulations.
3. Insurance claims have been processed directly with Bupa Qatar. Please verify your coverage details with your insurance provider. Any discrepancies should be reported within 14 days.
4. Orthodontic treatment is a long-term commitment. Regular adjustment appointments are scheduled every 4-6 weeks. Missed appointments may result in additional fees or treatment delays.
5. Patients are required to maintain excellent oral hygiene throughout the orthodontic treatment period. Failure to do so may result in additional dental procedures and charges.
6. This invoice is subject to the laws and regulations of the State of Qatar, including the Value Added Tax Law and the Ministry of Public Health guidelines for dental practices.
7. For any questions regarding this invoice or your orthodontic treatment plan, please contact our billing department at +974 4412 3456 or email [email protected].
8. Thank you for choosing Doha Elite Orthodontics Center for your orthodontic care needs in Qatar. We are committed to providing the highest standard of dental care in Doha.
Authorized Signature
Dr. Sarah Al-Mansouri
Lead Orthodontist
Doha Elite Orthodontics Center
Patient/Guardian Acknowledgment
Signature:
Date:
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