Invoice Orthodontist in Russia Saint Petersburg –Free Word Template Download with AI
Leading Dental Care in Russia Saint Petersburg
191025, Russia Saint Petersburg, Nevsky Prospect, 120, Office 45
Tax ID (INN): 7801234567 | KPP: 780101001
Phone: +7 (812) 555-01-99 | Email: [email protected]
Official Payment Request
Bill To: Alexei Ivanovich Volkov197101, Russia Saint Petersburg, Vasilievsky Island, 10th Line, 28
Phone: +7 (921) 123-45-67
Email: [email protected]
Dear Mr. Volkov, thank you for choosing the Petersburg Orthodontic Center for your dental health needs. As a premier Orthodontist practice located in the heart of Russia Saint Petersburg, we are dedicated to providing world-class alignment and aesthetic dental solutions. This invoice details the professional services rendered during your recent treatment phase.
| # | Description of Orthodontic Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray analysis, digital smile design, and treatment planning by lead Orthodontist. |
1 | 5,500.00 | 5,500.00 |
| 2 |
Custom Clear Aligner Fabrication (Phase 1) Set of 10 precision-molded aligners manufactured specifically for the patient's dental arch structure. |
1 | 45,000.00 | 45,000.00 |
| 3 |
Orthodontic Adjustment & Monitoring Visit Clinical assessment of tooth movement progress, fitting of new aligners, and hygiene instruction. |
2 | 3,500.00 | 7,000.00 |
| 4 |
Interproximal Reduction (IPR) Minor enamel reshaping to create space for optimal alignment, performed by certified specialist. |
1 | 4,200.00 | 4,200.00 |
| 5 |
Digital Intraoral Scan High-resolution 3D imaging for accurate tracking of orthodontic progress in Saint Petersburg clinic database. |
1 | 2,800.00 | 2,800.00 |
Payment Terms and Conditions
This invoice represents the official request for payment for orthodontic services provided by our clinic in Russia Saint Petersburg. Payment is due within 14 days of the invoice date. Please reference the Invoice Number (INV-2023-SPB-0892) on all payments.
Bank Transfer Details:
Bank Name: Sberbank of Russia
Beneficiary: OOO "Petersburg Orthodontic Center"
Account Number: 40702810938000123456
BIC: 044525225
Correspondent Account: 30101810400000000225
Clinic Policy: As your dedicated Orthodontist, we ensure that all treatments adhere to the highest medical standards. Failure to pay this invoice by the due date may result in a temporary suspension of future orthodontic adjustments and aligner deliveries. We appreciate your prompt attention to this matter to ensure the continuity of your treatment plan.
Authorized Signature:Dr. Elena Petrova
Chief Orthodontist
Petersburg Orthodontic Center Accepted By (Patient):
_________________________
Date: ___________________ ⬇️ Download as DOCX Edit online as DOCX
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