Invoice Orthodontist in Spain Barcelona –Free Word Template Download with AI
Dr. Elena Martinez, DDS, MSc Orthodontics
Carrer de Balmes, 150, 4th Floor
08008 Barcelona, Spain
NIF: B-12345678
Phone: +34 93 123 45 67
Email: [email protected]
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Mr. James Anderson
Av. Diagonal, 456, Apt 12B
08006 Barcelona, Spain
NIF/NIE: X-9876543-Z
Email: [email protected]
| # | Description of Orthodontic Services | Code | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic radiography, cephalometric analysis, and digital intraoral scanning to assess malocclusion severity and formulate a treatment plan. |
ORT-001 | 1 | 150.00 | 150.00 |
| 2 |
Phase 1: Interceptive Orthodontic Treatment Application of removable functional appliance to correct skeletal Class II malocclusion. Includes monthly adjustment visits for a period of 6 months. |
ORT-105 | 1 | 1,200.00 | 1,200.00 |
| 3 |
Phase 2: Fixed Appliance Therapy (Braces) Placement of self-ligating ceramic brackets on upper and lower arches. Includes archwire changes, ligature replacements, and monthly progress checks for 18 months. |
ORT-210 | 1 | 3,500.00 | 3,500.00 |
| 4 |
Interproximal Reduction (IPR) Selective enamel stripping to create space for alignment and improve contact points. Performed on 12 teeth. |
ORT-045 | 1 | 250.00 | 250.00 |
| 5 |
Temporary Anchorage Devices (TADs) Surgical placement of two mini-implants in the maxillary region to provide absolute anchorage for molar distalization. Includes removal fee. |
ORT-300 | 2 | 400.00 | 800.00 |
| 6 |
Retention Phase Fabrication and delivery of custom Essix retainers (upper and lower) and bonding of fixed lingual retainer on lower anterior teeth. |
ORT-400 | 1 | 350.00 | 350.00 |
| 7 |
Emergency Orthodontic Visit Repair of broken bracket and archwire adjustment due to trauma. |
ORT-999 | 1 | 75.00 | 75.00 |
Payment Instructions & Notes:
Please make payment within 30 days of the invoice date to avoid late fees. Payments can be made via bank transfer or credit card.
Bank Transfer Details:
Bank: Banco Santander
IBAN: ES91 2100 0418 4502 0005 1332
BIC/SWIFT: BSCHESMM
Reference: INV-2023-10-045
Important: This invoice reflects the total cost of orthodontic treatment rendered at our Barcelona clinic. As per Spanish tax regulations, medical services are subject to VAT (IVA) unless specifically exempted. Please retain this document for your records and insurance claims.
Terms and Conditions: This invoice is issued in accordance with the Spanish Tax Agency (Agencia Tributaria) regulations. All prices are in Euros (€). Late payments may incur interest charges at the statutory rate. Disputes regarding this invoice must be raised within 15 days of receipt. By accepting our orthodontic services, the patient agrees to the treatment plan and financial responsibilities outlined herein. Barcelona Advanced Orthodontics is committed to providing high-quality dental care in compliance with the standards set by the Catalan College of Dentists (COIDC).
Thank you for choosing Barcelona Advanced Orthodontics for your dental health needs. We appreciate your trust in our expertise and look forward to helping you achieve a healthy, beautiful smile.
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