Invoice Orthodontist in Spain Madrid –Free Word Template Download with AI
Dr. Alejandro Ruiz & Associates
Calle de Alcalá, 123, 28009 Madrid, Spain
Phone: +34 91 123 4567 | Email: [email protected]
NIF: B-12345678 | College Registration: M-98765
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
BILLING INFORMATION
Bill To:
Ms. Elena Fernandez Garcia
Calle de Serrano, 45, 28001 Madrid, Spain
NIF: 12345678Z
Patient Name:
Lucas Fernandez Ruiz
Health Insurance: Sanitas Premium
Policy Number: INS-99887766
| # | Description of Orthodontic Services | Date | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes panoramic X-ray, cephalometric analysis, and digital intraoral scanning for treatment planning. |
2023-09-15 | 1 | 150.00 | 150.00 |
| 2 |
Custom Clear Aligner Therapy (Phase 1) Manufacturing and delivery of the first set of 10 custom-fitted aligners for anterior alignment correction. |
2023-09-20 | 1 | 1,200.00 | 1,200.00 |
| 3 |
Interproximal Reduction (IPR) Minimal enamel stripping procedure to create necessary space for tooth movement. |
2023-09-20 | 1 | 120.00 | 120.00 |
| 4 |
Monthly Progress Monitoring Visit Clinical evaluation of tooth movement, aligner fit check, and hygiene assessment. |
2023-10-15 | 1 | 80.00 | 80.00 |
| 5 |
Replacement Aligner Set Fabrication of replacement aligners due to accidental loss of previous set. |
2023-10-18 | 1 | 150.00 | 150.00 |
| Subtotal: | 1,700.00 € |
| VAT (IVA 21%): | 357.00 € |
| Total Amount Due: | 2,057.00 € |
Payment Instructions & Important Notes
Bank Transfer Details:
Bank: Banco Santander, Madrid Branch
IBAN: ES91 2100 0418 4502 0005 1332
BIC/SWIFT: BSCHESMMXXX
Please reference Invoice Number INV-2023-10-045 in the transfer description.
Terms and Conditions:
1. This invoice represents services rendered by a licensed Orthodontist in Madrid, Spain, in accordance with the regulations of the Colegio Oficial de Odontólogos y Estomatólogos de Madrid.
2. Payment is due within 30 days of the invoice date. Late payments may incur a statutory interest charge as per Spanish law.
3. If you have private health insurance, please submit this invoice along with the clinical report to your provider for reimbursement processing.
4. Please retain this document for your personal financial records.
Authorized Signature
Dr. Alejandro Ruiz
Lead Orthodontist
Received By
Date: _______________
Signature: _______________
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