Invoice Orthodontist in Zimbabwe Harare –Free Word Template Download with AI
Dr. Tendai Moyo, BDS, MSc Orthodontics
123 Samora Machel Avenue, Borrowdale
Harare, Zimbabwe
Tel: +263 242 700 123 | Mobile: +263 772 456 789
Email: [email protected]
PRAC No: ZDHA/2023/0456 | Tax ID: ZIM-987654321
Invoice Number: INV-2024-0892
Date Issued: 15 November 2024
Due Date: 30 November 2024
Payment Status: PENDING
BILL TO:
Mr. & Mrs. Brian Chikwanha
456 Robert Mugabe Road
Avondale, Harare, Zimbabwe
Phone: +263 771 234 567
Email: [email protected]
PATIENT DETAILS:
Patient Name: Sarah Chikwanha
Date of Birth: 12 March 2010
Medical Aid: Discovery Health Zimbabwe
Policy Number: DHZ-9876543210
Treatment Plan ID: TP-2024-0456
| # | Description of Orthodontic Services | Date of Service | Quantity | Unit Price (USD) | Total (USD) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Comprehensive Examination including panoramic X-ray and cephalometric analysis at our Harare clinic | 01 Oct 2024 | 1 | 150.00 | 150.00 |
| 2 | Diagnostic Records: Full set of dental impressions, study models, and intraoral photography for treatment planning | 01 Oct 2024 | 1 | 100.00 | 100.00 |
| 3 | Fixed Orthodontic Appliance (Metal Braces) - Upper Arch: Includes brackets, archwires, and bonding materials | 15 Oct 2024 | 1 | 1,200.00 | 1,200.00 |
| 4 | Fixed Orthodontic Appliance (Metal Braces) - Lower Arch: Includes brackets, archwires, and bonding materials | 15 Oct 2024 | 1 | 1,200.00 | 1,200.00 |
| 5 | Orthodontic Adjustment Appointment - First monthly review and wire change at Harare Precision Orthodontics | 12 Nov 2024 | 1 | 75.00 | 75.00 |
| 6 | Orthodontic Adjustment Appointment - Second monthly review and wire change at Harare Precision Orthodontics | 15 Nov 2024 | 1 | 75.00 | 75.00 |
| 7 | Emergency Orthodontic Repair: Replacement of broken bracket on upper right first molar | 08 Nov 2024 | 1 | 50.00 | 50.00 |
| 8 | Orthodontic Elastics (Rubber Bands) - 3-month supply for bite correction | 15 Oct 2024 | 3 | 15.00 | 45.00 |
| Subtotal: | $3,895.00 |
| Medical Aid Contribution (Discovery Health Zimbabwe): | -$1,500.00 |
| Early Payment Discount (2% if paid within 14 days): | -$77.90 |
| TOTAL AMOUNT DUE: | $2,317.10 |
Payment Instructions & Terms:
All orthodontic treatment fees at Harare Precision Orthodontics are quoted in United States Dollars (USD) in accordance with Zimbabwe's current monetary policy. This invoice reflects the professional orthodontic services rendered in Harare, Zimbabwe.
Payment Methods Accepted:
- Bank Transfer: First National Bank Zimbabwe (FNB), Harare Branch. Account Name: Harare Precision Orthodontics (Pvt) Ltd. Account Number: 1234567890123. Branch Code: 250605. Please quote Invoice Number INV-2024-0892.
- ECOCash/OneMoney: +263 772 456 789 (Harare Precision Orthodontics). Please send payment reference with patient name.
- Cash: USD cash payments accepted at our Harare clinic during business hours.
- Visa/Mastercard: Card payments accepted at the clinic reception.
Terms and Conditions:
- Payment is due within 15 days of the invoice date. Late payments may incur a 5% monthly interest charge.
- Medical aid claims are submitted directly to Discovery Health Zimbabwe on behalf of the patient. The patient is responsible for any shortfall between the medical aid contribution and the total fee.
- This invoice covers orthodontic services provided at our Harare clinic. Additional treatment phases will be invoiced separately.
- Regular orthodontic adjustment appointments are scheduled monthly. Missed appointments may result in treatment delays and additional fees.
- Patients are responsible for maintaining good oral hygiene during orthodontic treatment. Poor hygiene may require additional professional cleaning services, which will be invoiced separately.
- In case of emergency orthodontic issues (broken brackets, loose wires), please contact our Harare clinic immediately. Emergency repairs are billed at the standard rate shown above.
Important Notice for Zimbabwe Patients:
Due to Zimbabwe's dual currency system, all payments should be made in USD. If paying in Zimbabwe Gold (ZiG), the exchange rate will be applied at the prevailing Reserve Bank of Zimbabwe rate on the date of payment. Please confirm the exchange rate with our billing department before making payment in ZiG.
Authorized by:
Dr. Tendai MoyoLead Orthodontist
Harare Precision Orthodontics
Received by:
Patient/Guardian SignatureDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
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