Invoice Veterinarian in United States Chicago –Free Word Template Download with AI
2450 N. Lake Shore Drive, Suite 310
Chicago, Illinois 60614, United States
Phone: (312) 555-0187 | Fax: (312) 555-0188
Email: [email protected]
Tax ID (EIN): 36-4829175
Licensed Veterinarian Practice – State of IllinoisBilled To (Client)
Mr. Jonathan R. Whitfield
1847 W. Belmont Avenue, Apt 4B
Chicago, Illinois 60657, United States
Phone: (773) 555-2294
Email: [email protected]
Client ID: CL-2023-00914
Patient Information
Pet Name: Biscuit
Species: Canine (Dog)
Breed: Golden Retriever
Age: 4 years, 2 months
Sex: Male (Neutered)
Weight: 68 lbs (30.8 kg)
Microchip #: 985-112-334-5567
| # | Service / Description | Veterinarian / Provider | Qty | Unit Price | Amount |
|---|---|---|---|---|---|
| 1 | Comprehensive Annual Wellness Examination – Full physical assessment including orthopedic, cardiac, dental, and ophthalmologic evaluation performed by our lead Veterinarian | Dr. Sarah M. Chen, DVM | 1 | $185.00 | $185.00 |
| 2 | Core Vaccinations – DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus) and Rabies (3-year) administered per Illinois Department of Public Health requirements | Dr. Sarah M. Chen, DVM | 1 | $120.00 | $120.00 |
| 3 | Non-Core Vaccination – Bordetella (Intranasal) and Leptospirosis (4-strain) for protection against common Chicago-area zoonotic and respiratory pathogens | Dr. Marcus T. Okafor, DVM | 1 | $95.00 | $95.00 |
| 4 | Complete Blood Count (CBC) and Serum Biochemistry Panel – In-house laboratory analysis to evaluate organ function, blood cell morphology, and metabolic markers | Lab Services – Chicago Lakeside | 1 | $145.00 | $145.00 |
| 5 | Fecal Parasitology and Urinalysis – Screening for intestinal parasites and urinary tract abnormalities as part of the annual preventive care protocol | Lab Services – Chicago Lakeside | 1 | $65.00 | $65.00 |
| 6 | Dental Prophylaxis (COHAT) – Ultrasonic scaling, subgingival curettage, full-mouth dental radiographs (14 views), and polishing under general anesthesia | Dr. Marcus T. Okafor, DVM | 1 | $620.00 | $620.00 |
| 7 | General Anesthesia and Monitoring – Isoflurane inhalant anesthesia with continuous ECG, SpO2, and temperature monitoring throughout the dental procedure | Anesthesia Team | 1 | $275.00 | $275.00 |
| 8 | Extraction of Two Premolars (Tooth #205 and #306) – Removal of severely periodontally compromised teeth with alveolar curettage and hemostasis | Dr. Marcus T. Okafor, DVM | 2 | $110.00 | $220.00 |
| 9 | Post-Operative Pain Management – Carprofen (Rimadyl) 75 mg tablets, 30-day supply, dispensed per Veterinarian prescription for dental recovery | Pharmacy – Chicago Lakeside | 1 | $89.00 | $89.00 |
| 10 | Heartworm Preventive – Bravecto Plus (Fluralaner + Moxidectin) 28–55 lb dose, 3-month oral chewable, dispensed by our in-house pharmacy | Pharmacy – Chicago Lakeside | 1 | $135.00 | $135.00 |
| 11 | Follow-Up Telephone Consultation – 15-minute post-operative check-in call by the attending Veterinarian to assess healing and answer client questions | Dr. Sarah M. Chen, DVM | 1 | $45.00 | $45.00 |
| Subtotal | $2,194.00 |
| Illinois State Sales Tax (10.25%) | $224.88 |
| City of Chicago Municipal Tax (2.5%) | $54.85 |
| Insurance Adjustment (Petplan – Policy #PP-88234) | -$1,097.00 |
| CLIENT BALANCE DUE | $1,376.73 |
Payment Terms & Instructions
This Invoice is payable within thirty (30) days of the Invoice date. Please make checks payable to Chicago Lakeside Veterinary Clinic and mail to our billing office at 2450 N. Lake Shore Drive, Suite 310, Chicago, IL 60614, United States.
Alternative payment methods accepted: Visa, Mastercard, American Express, Discover, Apple Pay, and ACH bank transfer. A convenience fee of 2.9% applies to credit card transactions processed over the phone.
For ACH transfers, please reference Invoice Number INV-2025-004872 in the memo field. Our bank details are available upon request by contacting our billing department at (312) 555-0187, Monday through Friday, 8:00 AM to 6:00 PM Central Time.
A late payment fee of 1.5% per month will be assessed on any balance remaining after the due date of July 14, 2025, in accordance with Illinois commercial collection statutes.
Important Notes from Your Veterinarian
Dear Mr. Whitfield, thank you for entrusting Biscuit's care to our team here in United States Chicago. The dental procedure went well, and Biscuit recovered from anesthesia without complication. Please ensure he is fed soft food for the next five days and monitor the extraction sites for any excessive bleeding or swelling.
A follow-up in-clinic recheck is scheduled for June 26, 2025, at 10:30 AM to confirm proper healing. If you notice any signs of infection (pus, foul odor, refusal to eat, or lethargy), please contact our office immediately at (312) 555-0187. Our emergency line is available 24/7 at (312) 555-0199.
As a reminder, Biscuit's next annual wellness visit and booster vaccinations are due in June 2026. We encourage you to schedule this appointment in advance to secure a convenient time slot with your preferred Veterinarian.
This Invoice has been prepared in compliance with the Illinois Veterinary Practice Act (225 ILCS 110) and all applicable federal and local billing regulations for the City of Chicago, Cook County, and the State of Illinois, United States.
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