Invoice Orthodontist in Singapore Singapore –Free Word Template Download with AI
123 Orchard Road, #05-01
Singapore Singapore 238858
Tel: +65 6789 1234 | Email: [email protected]
UEN: 202312345K
Invoice No: INV-2024-0876
Date: 15 October 2024
Due Date: 15 November 2024
Bill To:
Patient Name: Mr. Jonathan Tan Wei Ming
NRIC: S8901234A
Address: 456 Bukit Timah Road, #12-03, Singapore Singapore 259725
Contact: +65 9876 5432
Email: [email protected]
Service Period: 01 September 2024 – 30 September 2024
Treatment Plan: Comprehensive Fixed Appliance Orthodontic Treatment (Braces)
Referring Dentist: Dr. Lim Siew Hua (General Dentistry)
Insurance Provider: Great Eastern Life Assurance (Policy No: GE-987654321)
| Description of Orthodontic Services | Quantity | Unit Price (SGD) | Total (SGD) |
|---|---|---|---|
| Initial Orthodontic Consultation & Diagnostic Records (X-rays, Photographs, Impressions) | 1 | 350.00 | 350.00 |
| Treatment Planning & Digital Smile Simulation | 1 | 200.00 | 200.00 |
| Placement of Fixed Metal Brackets (Upper & Lower Arch) | 1 | 4,500.00 | 4,500.00 |
| Monthly Adjustment & Progress Monitoring (September 2024) | 1 | 250.00 | 250.00 |
| Emergency Visit – Bracket Replacement (18 September 2024) | 1 | 150.00 | 150.00 |
| Interproximal Enamel Reduction (IPR) – Minor Stripping | 1 | 300.00 | 300.00 |
| Orthodontic Elastics & Ligature Replacement Kit | 2 | 50.00 | 100.00 |
| Professional Oral Hygiene Instruction for Orthodontic Patients | 1 | 100.00 | 100.00 |
Subtotal: SGD 6,050.00
GST (9%): SGD 544.50
Total Amount Due: SGD 6,594.50
Payment Terms & Notes:
This Invoice is issued by SmileCraft Orthodontics, a registered orthodontic practice in Singapore Singapore, in accordance with local healthcare billing standards. Payment is due within 30 days from the invoice date. Late payments may incur a 1.5% monthly interest charge.
Accepted payment methods: Bank Transfer (DBS/POSB), Credit/Debit Card (Visa, Mastercard), PayNow, or Cash. For bank transfer, please quote the Invoice Number as reference.
Insurance claims: This invoice can be submitted to your insurance provider for partial reimbursement under dental/orthodontic coverage. Please retain a copy for your records. Pre-authorization was obtained from Great Eastern Life Assurance for this treatment plan.
All orthodontic services rendered are performed by qualified orthodontists registered with the Singapore Dental Council. Treatment progress will be reviewed monthly, and additional invoices will be issued for subsequent phases of care.
If you have any questions regarding this invoice or your orthodontic treatment plan, please contact our billing department at +65 6789 1234 or email [email protected].
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