Invoice Orthodontist in Russia Moscow –Free Word Template Download with AI

Bill To:

Patient Name: Ivan Petrovich Sokolov

Address: 45 Leninsky Prospekt, Apt 12, Moscow, Russia, 119991

Phone: +7 (999) 876-54-32

Patient ID: PAT-88291

#	Description of Orthodontic Services	Quantity	Unit Price (RUB)	Total (RUB)
1	Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray analysis, cephalometric evaluation, and digital smile design assessment. This initial phase is critical for determining the severity of malocclusion and planning the specific treatment trajectory required for the patient residing in the Moscow metropolitan area.	1	5,000.00	5,000.00
2	Custom Clear Aligner Fabrication (First Set) Production of high-precision polyurethane aligners using 3D printing technology. This service covers the digital scanning of dental arches and the manufacturing of the initial series of aligners designed to correct anterior crowding.	1	45,000.00	45,000.00
3	Orthodontic Bonding and Bracket Placement Professional application of self-ligating ceramic brackets on the upper and lower arches. Includes etching, bonding agent application, and precise bracket positioning to ensure optimal force distribution during the orthodontic correction process.	1	35,000.00	35,000.00
4	Monthly Adjustment and Progress Monitoring Routine check-up appointment including wire changes, ligature replacement, and assessment of tooth movement progress. This recurring service ensures the treatment plan remains on schedule and addresses any discomfort or issues arising during the active phase of orthodontic therapy.	2	4,500.00	9,000.00
5	Interproximal Reduction (IPR) Minimal enamel stripping procedure to create necessary space for tooth alignment. Performed with specialized diamond strips to ensure safety and precision, facilitating the proper alignment of crowded teeth without the need for extractions.	1	8,000.00	8,000.00
6	Retainer Fabrication and Fitting Custom-made Essix retainers to maintain the new position of teeth following the active treatment phase. Includes two sets (day and night) and instructions on proper care and usage to prevent relapse of orthodontic issues.	1	12,000.00	12,000.00

Subtotal: 114,000.00 RUB VAT (20%): 22,800.00 RUB Discount (Loyalty Program): -5,000.00 RUB TOTAL AMOUNT DUE: 131,800.00 RUB

Payment Instructions & Terms

Payment is due within 14 days of the invoice date. Please include the invoice number (INV-2023-10-0042) as the payment reference.

Bank Details:
Bank Name: Sberbank of Russia
Account Name: Moscow Elite Orthodontics LLC
Account Number: 40702810000000001234
BIC: 044525225
Correspondent Account: 30101810400000000225

Late payments may incur a penalty fee of 0.1% per day on the outstanding balance. Please contact our billing department immediately if you anticipate any difficulties in meeting the payment deadline.

This invoice is issued in accordance with the Federal Law of the Russian Federation "On Accounting" and the Tax Code of the Russian Federation. All services provided are subject to the standard warranty terms outlined in the patient service agreement signed at the time of initial consultation.

Moscow Elite Orthodontics is a licensed medical institution operating in the city of Moscow, Russia. All orthodontic procedures are performed by certified specialists with extensive experience in modern orthodontic techniques. This document serves as an official financial record of services rendered and is valid for tax purposes. The patient acknowledges receipt of this invoice and agrees to the terms and conditions of payment as specified herein. For any questions regarding this invoice or the orthodontic treatment plan, please do not hesitate to contact our administrative office during business hours (Monday to Friday, 9:00 AM to 6:00 PM Moscow Time). We are committed to providing the highest standard of dental care and ensuring a transparent billing process for all our patients in Russia.

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