Invoice Orthodontist in Saudi Arabia Riyadh –Free Word Template Download with AI
Specialized Orthodontist Services
Al Olaya District, King Fahd Road
Riyadh, 12211, Saudi Arabia
Phone: +966 11 234 5678
Email: [email protected]
VAT Registration Number: 310123456700003
Commercial Registration (CR): 1010XXXXXX
Date: October 24, 2023
Due Date: November 24, 2023
Invoice #: INV-2023-0892
Bill To:
Mr. Ahmed Al-Fahad
Al Malqa District
Riyadh, Saudi Arabia
Phone: +966 50 123 4567
Email: [email protected]
National ID: 1080XXXXXX
| Description of Orthodontic Services | Code | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|
| Initial Comprehensive Orthodontic Consultation and Diagnostic Records (X-rays, Impressions) | DO-001 | 1 | 450.00 | 450.00 |
| Placement of Fixed Metal Brackets (Full Arch - Upper and Lower) | DO-002 | 1 | 8,500.00 | 8,500.00 |
| Custom Archwires and Ligatures (Initial Setup) | DO-003 | 1 | 1,200.00 | 1,200.00 |
| Monthly Adjustment and Monitoring Visit (October 2023) | DO-004 | 1 | 350.00 | 350.00 |
| Interproximal Reduction (IPR) for Alignment | DO-005 | 1 | 600.00 | 600.00 |
| Emergency Visit for Bracket Repair | DO-006 | 1 | 250.00 | 250.00 |
Payment Instructions
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer or credit card at our Riyadh clinic.
Bank Name: Al Rajhi Bank
Account Name: Riyadh Elite Orthodontics Center
IBAN: SA03 8000 0000 6080 1016 7519
SWIFT Code: NATIONALSA
Reference: INV-2023-0892
Terms and Conditions & Important Notes
- This invoice is issued in accordance with the regulations of the Zakat, Tax and Customs Authority (ZATCA) in Saudi Arabia.
- All orthodontic treatments are performed by licensed specialists adhering to the standards of the Saudi Commission for Health Specialties (SCFHS).
- Late payments may incur a penalty fee as per Saudi commercial law.
- Insurance claims are subject to approval by the respective insurance provider. The patient is responsible for any non-covered amounts.
- Regular follow-up appointments are crucial for the success of orthodontic treatment. Please schedule your next visit promptly.
- For any questions regarding this invoice or your treatment plan, please contact our billing department in Riyadh.
Riyadh Elite Orthodontics Center Patient Acknowledgment
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