Invoice Orthodontist in Uzbekistan Tashkent –Free Word Template Download with AI
Specialized Dental Care Center
Address: Amir Temur Avenue, 45, Chilonzor District
Tashkent, Uzbekistan, 100000
Phone: +998 71 200-00-00
Email: [email protected]
TIN (Tax ID): 123456789
Official Payment Request
Bill To:
Mr. Azim Karimov
Residential Address: Yunusabad District, Street 12, House 5
Tashkent, Uzbekistan
Phone: +998 90 123-45-67
Patient ID: TO-2023-889
Subject: Professional Orthodontic Treatment Plan and Initial Consultation Fees.
This invoice represents the financial agreement for comprehensive orthodontic care provided by Tashkent Elite Orthodontics. As a leading provider of dental alignment solutions in Uzbekistan, we are committed to delivering world-class orthodontic results. The following charges cover the initial diagnostic phase, the fabrication of custom orthodontic appliances, and the first stage of active treatment. This document serves as an official record for your financial records and insurance purposes within the Republic of Uzbekistan.
| # | Description of Orthodontic Services | Quantity | Unit Price (UZS) | Total (UZS) |
|---|---|---|---|---|
| 1 |
Comprehensive Orthodontic Consultation & Diagnosis Includes panoramic X-ray, cephalometric analysis, and digital intraoral scanning. This initial assessment is crucial for determining the severity of malocclusion and planning the specific orthodontic intervention required for the patient. |
1 | 500,000 | 500,000 |
| 2 |
Pre-Treatment Dental Hygiene & Preparation Professional prophylaxis (scaling and polishing) to ensure optimal oral health before the placement of orthodontic brackets. This step is mandatory to prevent gingivitis during the treatment duration. |
1 | 350,000 | 350,000 |
| 3 |
Placement of Self-Ligating Metal Brackets (Full Arch) Supply and professional installation of high-grade stainless steel self-ligating brackets on both the upper and lower dental arches. This includes the bonding agent and isolation materials. |
1 | 4,500,000 | 4,500,000 |
| 4 |
Custom Orthodontic Archwires (Initial Phase) Fabrication and insertion of nickel-titanium archwires designed to apply gentle, continuous force to move teeth into the correct alignment. |
2 | 400,000 | 800,000 |
| 5 |
Interproximal Reduction (IPR) Procedure Minimal enamel stripping to create necessary space for tooth alignment, ensuring a stable and aesthetic bite result. |
1 | 600,000 | 600,000 |
| 6 |
First Month Adjustment & Follow-up Visit Scheduled appointment to check bracket integrity, adjust wire tension, and provide patient education on oral hygiene with braces. |
1 | 250,000 | 250,000 |
Payment Instructions & Terms
Please remit payment within 14 days of the invoice date to avoid service interruption. As per the financial regulations in Uzbekistan, payments can be made via the following methods:
- Bank Transfer: Payjoy Bank, Account No: 86010000000000000000, SWIFT: PAYJUZZ2.
- Digital Wallets: Payme or Click ID: +998 90 123-45-67.
- Cash: Accepted at our Tashkent clinic reception during business hours.
Important Note: This invoice is valid for tax deduction purposes in Uzbekistan. Please retain this document for your personal records. Failure to pay by the due date may result in a suspension of orthodontic adjustments.
Orthodontic Treatment Disclaimer
The patient acknowledges that orthodontic treatment is a medical procedure with inherent risks. The duration of treatment is estimated based on current clinical findings but may vary depending on the patient's biological response and compliance with instructions. Tashkent Elite Orthodontics is not responsible for delays caused by missed appointments or damage to appliances due to negligence. This invoice covers only the services listed above; future adjustments, emergency repairs, or retainer fabrication will be invoiced separately.
Authorized Signature (Clinic)
Dr. Dilnoza Rahimova
Chief Orthodontist
Patient Signature (Acknowledgement)
Date: _______________
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