Invoice Orthodontist in Saudi Arabia Jeddah –Free Word Template Download with AI
Specialized Orthodontist & Dental Care
Al-Rawdah District, King Abdullah Road
Jeddah, Makkah Province, Saudi Arabia
Commercial Registration (CR): 2030012345678
VAT Registration Number: 310123456789003
Phone: +966 12 345 6789 | Email: [email protected]
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Patient Name: Ahmed Mohammed Al-Fahad
National ID (Iqama): 1098765432
Address: Al-Shati District, Street 45, Building 12
City: Jeddah, Saudi Arabia
Phone: +966 50 123 4567
Insurance Provider: Bupa Arabia (Policy #BP-998877)
Orthodontic Services Rendered
This invoice details the professional orthodontic treatments provided at our clinic in Jeddah, Saudi Arabia. All procedures were performed in accordance with the standards set by the Saudi Commission for Health Specialties (SCFHS) and local health regulations.
| # | Description of Orthodontic Service | Code | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Orthodontic Consultation and Diagnosis in Jeddah | ORT-001 | 1 | 350.00 | 350.00 |
| 2 | Digital Panoramic X-Ray and Cephalometric Analysis | RAD-005 | 1 | 450.00 | 450.00 |
| 3 | Custom Impressions for Orthodontic Treatment Planning | ORT-010 | 1 | 200.00 | 200.00 |
| 4 | Placement of Fixed Metal Braces (Full Arch Upper and Lower) | ORT-105 | 1 | 8,500.00 | 8,500.00 |
| 5 | Interproximal Reduction (IPR) for Alignment | ORT-055 | 1 | 600.00 | 600.00 |
| 6 | Monthly Adjustment and Progress Monitoring Visit | ORT-200 | 1 | 300.00 | 300.00 |
| 7 | Orthodontic Elastics and Ligatures Replacement | ORT-210 | 1 | 150.00 | 150.00 |
| 8 | Emergency Repair of Dislodged Bracket | ORT-300 | 1 | 250.00 | 250.00 |
| Subtotal: | 10,800.00 SAR |
| VAT (15%): | 1,620.00 SAR |
| Total Amount Due: | 12,420.00 SAR |
Important Notes & Payment Instructions:
- Currency: All amounts are quoted in Saudi Riyals (SAR).
- VAT Compliance: This invoice includes the mandatory 15% Value Added Tax as per the regulations of the Zakat, Tax and Customs Authority (ZATCA) in Saudi Arabia.
- Payment Methods: Payments can be made via bank transfer, credit card, or cash at our Jeddah clinic. For bank transfers, please use the details below:
- Bank Name: Al Rajhi Bank
- Account Name: Al-Balad Orthodontic Center
- IBAN: SA03 8000 0000 6080 1016 7519
- SWIFT Code: NBSASARJ
- Insurance Claims: Please submit this invoice along with the treatment plan to your insurance provider for reimbursement if applicable.
- Next Appointment: Your next orthodontic adjustment is scheduled for November 24, 2023, at 10:00 AM.
- Validity: This invoice is valid for 30 days from the date of issue.
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