Invoice Veterinarian in United States Los Angeles –Free Word Template Download with AI
4821 Sunset Boulevard, Suite 210
Los Angeles, California 90027
United States
Phone: (323) 555-0147 | Fax: (323) 555-0148
Email: [email protected]
CA Veterinary License No. 48291 | DEA No. FJ4829103
Billed To (Client)
Ms. Rebecca Thompson
1247 Waverly Drive, Apt 3B
Los Angeles, California 90046
United States
Phone: (213) 555-8832
Email: [email protected]
Pet: Biscuit (Golden Retriever, 4 yrs)
Pet ID: WAC-PET-2021-00387
Attending Veterinarian
Dr. Marcus Chen, DVM, DACVIM
Board-Certified Internist
Westside Animal Care & Veterinary Clinic
Los Angeles, California
United States
Direct Line: (323) 555-0152
Referral Code: VET-MC-2025
Services Rendered – June 10, 2025
| # | Description of Service | CPT / Code | Qty | Unit Price | Amount |
|---|---|---|---|---|---|
| 1 | Comprehensive Wellness Examination – Full physical assessment including auscultation, palpation, ophthalmic exam, and dental evaluation performed by the attending Veterinarian at our Los Angeles, United States facility. | VET-90600 | 1 | $185.00 | $185.00 |
| 2 | Digital Radiography (4 views) – Thoracic and abdominal series to evaluate suspected gastrointestinal distress. Imaging performed at our Veterinarian clinic in Los Angeles, United States. | VET-71010 | 1 | $240.00 | $240.00 |
| 3 | Complete Blood Count (CBC) & Serum Biochemistry Panel – 24-item laboratory analysis including liver enzymes, renal values, electrolytes, and glucose. Processed by our in-house laboratory in Los Angeles, United States. | VET-84103 | 1 | $165.00 | $165.00 |
| 4 | Urinalysis with Sediment Examination – Full urinalysis including specific gravity, pH, protein, glucose, and microscopic sediment review conducted by the Veterinarian team. | VET-82043 | 1 | $75.00 | $75.00 |
| 5 | Abdominal Ultrasound – Real-time sonographic imaging of liver, spleen, kidneys, and intestinal tract. Performed by the Veterinarian at our Los Angeles, United States practice. | VET-76700 | 1 | $320.00 | $320.00 |
| 6 | Subcutaneous Fluid Therapy (Lactated Ringer's) – 500 mL administered over 2 hours for mild dehydration. Nursing care and monitoring included. | VET-96413 | 1 | $95.00 | $95.00 |
| 7 | Prescription Medication – Omeprazole 20 mg, 30 tablets (GI protective agent). Dispensed by our Veterinarian pharmacy in Los Angeles, United States. | Rx-OMEP-30 | 1 | $42.00 | $42.00 |
| 8 | Prescription Medication – Maropitant (Cerenia) 16 mg, 10 tablets (anti-emetic). Dispensed by the Veterinarian. | Rx-CER-10 | 1 | $88.00 | $88.00 |
| 9 | Follow-up Consultation (15 min) – Telephone follow-up by the Veterinarian to review laboratory results and adjust treatment plan. Conducted from our Los Angeles, United States office. | VET-99213 | 1 | $65.00 | $65.00 |
| 10 | Prescription Diet – Hill's i/d Digestive Care, 4 lb bag (therapeutic gastrointestinal formula). Recommended by the Veterinarian for 30-day trial. | Diet-HILL-ID-4 | 1 | $58.00 | $58.00 |
| Subtotal | $1,333.00 |
| Applicable Tax (CA Sales Tax 9.5%) | $126.64 |
| Insurance Adjustment (PetSmart Health Plan #PSH-44821) | -$412.00 |
| Grand Total Due | $1,047.64 |
Payment Terms & Instructions
This Invoice is payable within thirty (30) calendar days from the Invoice date of June 14, 2025. The total amount due is $1,047.64 USD. Please make checks payable to Westside Animal Care & Veterinary Clinic and mail to our billing office at 4821 Sunset Boulevard, Suite 210, Los Angeles, CA 90027, United States.
Alternative payment methods accepted: Visa, Mastercard, American Express, Discover, ACH bank transfer, and Apple Pay. For ACH transfers, please reference Invoice Number WAC-2025-07842 in the memo field. Our banking details are available upon request by contacting our billing department at (323) 555-0147.
A late payment fee of 1.5% per month will be applied to any balance remaining after the due date of July 14, 2025, in accordance with California commercial code provisions applicable to veterinary services in Los Angeles, United States.
Notes & Additional Information
This Invoice reflects all veterinary services rendered to your pet Biscuit during the visit on June 10, 2025, at our Veterinarian practice in Los Angeles, United States. The attending Veterinarian, Dr. Marcus Chen, has recommended a follow-up examination in four weeks to reassess gastrointestinal function and review repeat laboratory work.
Please retain this Invoice for your personal records and for any future insurance claims or tax documentation. If you have questions regarding any line item on this Invoice, please contact our billing team at [email protected] or call (323) 555-0147 between 8:00 AM and 6:00 PM Pacific Time, Monday through Friday.
Westside Animal Care & Veterinary Clinic is a licensed veterinary practice operating in compliance with all regulations set forth by the California Veterinary Medical Board. All services listed on this Invoice were performed by or under the direct supervision of a licensed Veterinarian in the State of California, United States.
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