Invoice Orthodontist in Sri Lanka Colombo –Free Word Template Download with AI
No. 45, Galle Road, Colombo 03,
Sri Lanka Colombo
Tel: +94 11 234 5678
Email: [email protected]
VAT Reg No: 123456789V
INVOICE
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Bill To|
Mr. Arjuna Perera No. 12, Lake House Gardens, Colombo 07, Sri Lanka Colombo Phone: +94 77 123 4567 |
Patient ID: P-45892 Treatment Plan: Comprehensive Braces Attending Orthodontist: Dr. S. Fernando |
This invoice details the professional fees for orthodontic services rendered at our clinic in Sri Lanka Colombo. As a leading provider of dental alignment solutions, we are committed to delivering high-quality care. The following items reflect the initial consultation, diagnostic imaging, and the commencement of active treatment for the patient listed above.
| # | Description of Service | Quantity | Unit Price (LKR) | Total (LKR) |
|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation Comprehensive examination of dental arches, bite analysis, and discussion of treatment options including fixed appliances and clear aligners. |
1 | 5,000.00 | 5,000.00 |
| 2 |
Diagnostic Imaging & Records Includes panoramic X-ray (OPG), lateral cephalometric radiograph, and intra-oral photography required for precise treatment planning. |
1 | 8,500.00 | 8,500.00 |
| 3 |
Impressions & Study Models Creation of physical dental models to analyze tooth positioning and occlusion. |
1 | 4,000.00 | 4,000.00 |
| 4 |
Fixed Orthodontic Appliance (Metal Braces) Supply and bonding of high-grade stainless steel brackets and archwires for both upper and lower arches. |
1 | 180,000.00 | 180,000.00 |
| 5 |
Initial Adjustment & Activation First appointment to place the archwire and activate the orthodontic force system. |
1 | 10,000.00 | 10,000.00 |
| Subtotal: | 207,500.00 |
| Discount (Early Bird): | -7,500.00 |
| VAT (8%): | 16,000.00 |
| TOTAL DUE (LKR): | 216,000.00 |
Please remit payment within 14 days of the invoice date. As this is a medical invoice for orthodontic treatment in Sri Lanka Colombo, we accept various payment methods to ensure convenience for our patients.
- Bank Transfer: Commercial Bank of Ceylon, Colombo Branch. Account Name: Colombo Elite Orthodontics. Account No: 1234-5678-9012.
- Credit/Debit Card: Visa and Mastercard accepted at the clinic reception.
- Cash: Sri Lankan Rupees (LKR) accepted at the clinic.
Terms and Conditions
1. This invoice represents the initial phase of the orthodontic treatment plan. Subsequent adjustment visits will be billed according to the agreed-upon installment plan.
2. Late payments may incur a penalty fee of 1.5% per month.
3. Please quote the Invoice Number (INV-2023-0892) when making payments.
4. This document serves as an official receipt for tax purposes in Sri Lanka.
5. For any queries regarding this invoice or your orthodontic treatment, please contact our billing department at the Colombo clinic address listed above.
Authorized Signature
Dr. S. Fernando
Lead Orthodontist
Patient Acknowledgement
Mr. Arjuna Perera
Date: _______________
Thank you for choosing Colombo Elite Orthodontics for your dental care needs.
Generating a beautiful smile in the heart of Sri Lanka Colombo.
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