Invoice Orthodontist in United Arab Emirates Dubai –Free Word Template Download with AI
Building 15, Sheikh Zayed Road
Dubai, United Arab Emirates
Phone: +971 4 123 4567
Email: [email protected]
TRN: 100123456700003
Invoice Number: INV-2023-0892
Date: October 24, 2023
Due Date: November 24, 2023
Bill To:
Mr. Ahmed Al-Mansoori
Villa 42, Palm Jumeirah
Dubai, United Arab Emirates
Phone: +971 50 987 6543
Email: [email protected]
Service Details:
Patient Name: Sara Al-Mansoori
Treatment Plan: Comprehensive Orthodontic Correction
Consultation Date: September 15, 2023
Insurance Provider: Daman Insurance (Partial Coverage)
| Description | Quantity | Unit Price (AED) | Total (AED) |
|---|---|---|---|
| Initial Orthodontic Consultation and Diagnostic Records | 1 | 500.00 | 500.00 |
| Comprehensive Treatment Planning (Digital Imaging & Analysis) | 1 | 1,200.00 | 1,200.00 |
| Installation of Self-Ligating Braces (Full Arch) | 1 | 15,000.00 | 15,000.00 |
| Monthly Adjustment and Monitoring Visits (6 Months) | 6 | 350.00 | 2,100.00 |
| Interproximal Reduction (IPR) Procedures | 1 | 800.00 | 800.00 |
| Custom Retainer Fabrication (Post-Treatment) | 2 | 600.00 | 1,200.00 |
| Emergency Orthodontic Repair (Bracket Replacement) | 1 | 250.00 | 250.00 |
Subtotal: AED 21,050.00
VAT (5%): AED 1,052.50
Insurance Adjustment: -AED 5,000.00
Total Amount Due: AED 17,102.50
Terms and Conditions:
1. Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.
2. This invoice is issued in accordance with the tax regulations of the United Arab Emirates Dubai.
3. All orthodontic services are provided by licensed professionals registered with the Dubai Health Authority.
4. Insurance claims have been processed separately; any discrepancies should be reported within 14 days.
5. Retainers must be worn as prescribed to ensure the longevity of treatment results.
6. For questions regarding this invoice, please contact our billing department at [email protected].
Create your own Word template with our GoGPT AI prompt:
GoGPT