Invoice Orthodontist in United Kingdom London –Free Word Template Download with AI
123 Harley Street, Marylebone
London, W1G 7AA
United Kingdom
Tel: +44 (0)20 7123 4567
Email: [email protected]
Company Reg: 12345678 | VAT Reg: GB 123 4567 89
Invoice No: LE-2023-8942
Date: 24 October 2023
Due Date: 24 November 2023
Reference: Treatment Plan Phase 1
Bill To (Parent/Guardian)
Mr. James Anderson
45 Kensington Gardens Square
London, W2 4BH
United Kingdom
Email: [email protected]
Patient Details
Patient Name: Emily Anderson
Date of Birth: 12 May 2010
NHS Number: 485 777 2221
Consultant Orthodontist: Dr. Sarah Jenkins, BDS, MOrth RCS Eng
| # | Description of Orthodontic Services | Date of Service | Unit Price (£) | Total (£) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Orthodontic Consultation Includes clinical examination of occlusion, assessment of skeletal and dental relationships, and discussion of treatment options suitable for the patient's age and condition within the London practice standards. |
01 Sep 2023 | 150.00 | 150.00 |
| 2 |
Diagnostic Records & Imaging Full set of orthodontic study models (digital scans), panoramic radiograph (OPG), and lateral cephalometric X-ray. Essential for precise treatment planning in complex orthodontic cases. |
01 Sep 2023 | 250.00 | 250.00 |
| 3 |
Fixed Appliance Therapy (Braces) - Upper Arch Bonding of self-ligating ceramic brackets to the maxillary arch. Includes archwire insertion and initial alignment. This is a premium aesthetic option chosen by the patient. |
15 Sep 2023 | 2,200.00 | 2,200.00 |
| 4 |
Fixed Appliance Therapy (Braces) - Lower Arch Bonding of self-ligating ceramic brackets to the mandibular arch. Includes archwire insertion and initial alignment to correct crowding and overjet. |
15 Sep 2023 | 2,200.00 | 2,200.00 |
| 5 |
Intermaxillary Elastics & Auxiliaries Provision of elastic bands and power chains to assist in correcting the bite relationship (Class II correction). Includes monthly adjustments and replacement of auxiliaries. |
01 Oct 2023 | 300.00 | 300.00 |
| 6 |
Emergency Appointment Fee Treatment for a loose bracket on the upper right first molar. Includes rebonding and adjustment of the archwire to maintain treatment progress. |
20 Oct 2023 | 75.00 | 75.00 |
Payment Terms & Important Information
Payment Deadline: Payment is due within 30 days of the invoice date. Late payments may incur interest charges at 4% above the Bank of England base rate.
Payment Methods: We accept Bank Transfer (BACS), Credit/Debit Cards (Visa, Mastercard, Amex), and Cheques made payable to "London Elite Orthodontics".
Bank Details:
Bank: Barclays Bank PLC
Sort Code: 20-00-00
Account Name: London Elite Orthodontics Ltd
Account Number: 12345678
Reference: Please use Invoice No. LE-2023-8942
Orthodontic Treatment Note: This invoice covers the initial phase of fixed appliance therapy. Regular monthly reviews are essential to ensure the teeth are moving correctly. Please contact our London clinic immediately if you experience pain or if any brackets become loose. Failure to attend appointments may result in additional charges or discontinuation of treatment.
Compliance: This invoice complies with HM Revenue & Customs (HMRC) requirements for VAT registration in the United Kingdom.
Authorized Signature
Dr. Sarah Jenkins
Lead Orthodontist
Received By
__________________________
Date: __________________________
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