Invoice Orthodontist in Tanzania Dar es Salaam –Free Word Template Download with AI
Plot No. 45, Sam Nujoma Road
Mikocheni, Dar es Salaam, Tanzania
Tel: +255 22 211 5500 | Email: [email protected]
TIN: 123-456-789-00-000
Official Payment Request
Bill To:
Patient Name: John Doe
Address: House No. 12, Masaki Peninsula
City: Dar es Salaam, Tanzania
Phone: +255 712 345 678
Email: [email protected]
| # | Description of Orthodontic Services | Date | Quantity | Unit Price (TZS) | Total (TZS) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Detailed clinical examination of the patient's dentition and facial profile. This includes the assessment of occlusion, jaw alignment, and periodontal health. The Orthodontist provided a preliminary diagnosis and discussed potential treatment pathways suitable for the patient's specific anatomical needs within the context of modern orthodontic standards practiced in Dar es Salaam. |
2023-09-05 | 1 | 150,000 | 150,000 |
| 2 |
Diagnostic Imaging and Records Acquisition of panoramic radiographs (OPG) and lateral cephalometric X-rays. These images are critical for the Orthodontist to analyze the skeletal relationship and root positions. Additionally, this item covers the taking of high-resolution intraoral photographs and digital impressions required for the fabrication of custom appliances. |
2023-09-05 | 1 | 250,000 | 250,000 |
| 3 |
Custom Fabrication of Fixed Orthodontic Appliances (Braces) Manufacturing and supply of high-grade stainless steel brackets and archwires. This service includes the precise selection of bracket sizes and the bonding of brackets to the maxillary and mandibular teeth. The materials used are imported to ensure durability and efficiency, adhering to the quality standards expected by patients in Tanzania. |
2023-09-15 | 1 | 1,500,000 | 1,500,000 |
| 4 |
Orthodontic Adjustment and Progress Monitoring Routine follow-up visit conducted by the lead Orthodontist. Services included the tightening of archwires, replacement of ligatures, and assessment of tooth movement progress. The Orthodontist verified that the treatment is proceeding according to the planned timeline and addressed any discomfort reported by the patient. |
2023-10-10 | 1 | 100,000 | 100,000 |
| 5 |
Emergency Orthodontic Repair Unscheduled visit to address a loose bracket on the lower left canine. The Orthodontist re-bonded the bracket and adjusted the archwire to prevent irritation to the soft tissues. This ensures the continuity of treatment without significant delays. |
2023-10-18 | 1 | 75,000 | 75,000 |
Terms, Conditions, and Payment Instructions
This Invoice represents the professional fees for orthodontic services rendered by Dar es Salaam Orthodontic Specialists. As a premier Orthodontist practice in Tanzania, we are committed to providing transparent billing and exceptional care.
Payment Methods: Payment can be made via bank transfer to CRDB Bank, Account Name: Dar es Salaam Orthodontic Specialists Ltd, Account Number: 0123456789012, Branch: Mikocheni. Mobile money payments via M-Pesa or Tigo Pesa are also accepted at +255 712 345 678.
Due Date: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
Medical Disclaimer: Orthodontic treatment is a medical procedure. While we strive for the best possible outcome, individual results may vary. This invoice covers the specific services listed above and does not guarantee future treatment costs unless explicitly stated in a separate treatment plan agreement.
Regulatory Compliance: This document is issued in accordance with the tax regulations of the Tanzania Revenue Authority (TRA). Please retain this invoice for your personal records and insurance claims.
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