Invoice Veterinarian in United States San Francisco –Free Word Template Download with AI
Licensed Veterinarian Practice • San Francisco, California • United States
1247 Market Street, Suite 300, San Francisco, CA 94102, United States
Phone: (415) 555-0187 • Email: [email protected]
CA Veterinary License No. 18472 • DEA Registration No. FG7291043
INVOICEInvoice Details
Invoice Number: GGVC-2025-04871
Invoice Date: June 12, 2025
Due Date: July 12, 2025
Service Date: June 10, 2025
Payment Terms: Net 30 Days
Billed To (Client)
Name: Margaret Elizabeth Thornton
Address: 892 Fillmore Street, Apt 4B
City/State/ZIP: San Francisco, CA 94115, United States
Phone: (415) 555-0342
Email: [email protected]
Client ID: CLT-2023-00914
Patient Information
Pet Name: Biscuit
Species: Canine (Dog)
Breed: Golden Retriever
Age: 7 years, 4 months
Sex: Male (Neutered)
Weight: 72 lbs (32.7 kg)
Microchip No.: 985-112-003-447-821
Attending Veterinarian
Dr. James R. Whitfield, DVM, DACVIM
Specialty: Internal Medicine & Geriatric Care
License: CA DVM License #18472
Department: Advanced Diagnostics & Surgery
Assistant: Sarah Kim, LVT (CVC)
The following Invoice reflects all veterinary services, diagnostics, medications, and supplies provided by our Veterinarian team at Golden Gate Veterinary Clinic in San Francisco, United States, during the patient's visit on June 10, 2025. All charges are itemized below for your records and insurance reimbursement purposes.
| # | Description of Service | Date | Qty | Unit Price | Amount |
|---|---|---|---|---|---|
| 1 | Comprehensive Geriatric Wellness Examination (including orthopedic assessment, cardiac auscultation, and neurological screening) | 06/10/2025 | 1 | $185.00 | $185.00 |
| 2 | Full Blood Panel (CBC, Chemistry 12, Urinalysis, Thyroid T4) for senior canine metabolic evaluation | 06/10/2025 | 1 | $245.00 | $245.00 |
| 3 | Digital Radiography – 4-View Thoracic and Abdominal Series (with digital imaging and interpretation by Veterinarian) | 06/10/2025 | 1 | $320.00 | $320.00 |
| 4 | Abdominal Ultrasound Examination (liver, spleen, kidneys, bladder, and pancreatic assessment) | 06/10/2025 | 1 | $410.00 | $410.00 |
| 5 | Electrocardiogram (ECG) – 12-Lead with Veterinarian Interpretation for cardiac rhythm analysis | 06/10/2025 | 1 | $175.00 | $175.00 |
| 6 | Prescription Medication: Carprofen 75mg Tablets (100-count bottle) – NSAID for joint inflammation management | 06/10/2025 | 1 | $68.50 | $68.50 |
| 7 | Prescription Medication: Omeprazole 20mg Capsules (60-count bottle) – Gastroprotective agent | 06/10/2025 | 1 | $42.00 | $42.00 |
| 8 | Subcutaneous Fluid Therapy (Lactated Ringer's Solution, 500mL) – Administered during diagnostic procedure | 06/10/2025 | 1 | $55.00 | $55.00 |
| 9 | Annual Rabies Vaccination (3-year license) – Required by San Francisco, United States municipal ordinance | 06/10/2025 | 1 | $45.00 | $45.00 |
| 10 | DHPP Booster Vaccination (Canine Distemper, Hepatitis, Parainfluenza, Parvovirus) | 06/10/2025 | 1 | $58.00 | $58.00 |
| 11 | Leishmania Antigen Test (in-house rapid diagnostic panel) – Recommended for canine in San Francisco, United States due to regional exposure risk | 06/10/2025 | 1 | $95.00 | $95.00 |
| 12 | Dental Prophylaxis (COHAT) – Ultrasonic scaling, polishing, and full-mouth dental radiographs (24 views) | 06/10/2025 | 1 | $580.00 | $580.00 |
| 13 | Extraction of 2 Premolars (Upper Left 10, Lower Right 20) – Performed under general anesthesia by Veterinarian | 06/10/2025 | 2 | $185.00 | $370.00 |
| 14 | General Anesthesia (Isoflurane) – Monitoring, induction, maintenance, and recovery for dental procedure (2.5 hours) | 06/10/2025 | 1 | $340.00 | $340.00 |
| 15 | Post-Operative Pain Management Kit (Gabapentin 100mg, 30-count + Ice pack + Recovery instructions) | 06/10/2025 | 1 | $38.00 | $38.00 |
| Subtotal | $3,026.50 |
|---|---|
| Insurance Adjustment (Petplan Policy #PP-882341) | -$1,210.60 |
| Client Copay (20%) | $605.30 |
| San Francisco Sales Tax (8.63%) | $52.24 |
| TOTAL DUE | $657.54 |
Accepted Payment Methods
- Check: Made payable to "Golden Gate Veterinary Clinic" – Mail to 1247 Market Street, Suite 300, San Francisco, CA 94102, United States
- Credit/Debit Card: Visa, Mastercard, American Express, Discover (call (415) 555-0187 to arrange)
- ACH Bank Transfer: Routing #121000358, Account #4472-9918-003 (Golden Gate Veterinary Clinic LLC)
- Online Payment: Visit pay.goldengatevet.com and reference Invoice Number GGVC-2025-04871
A late payment fee of 1.5% per month will be applied to any balance remaining after the due date of July 12, 2025. Please contact our billing department at (415) 555-0187 ext. 4 if you have questions regarding this Invoice or require a payment plan arrangement.
Veterinarian's Clinical Notes & Recommendations
Dear Ms. Thornton, thank you for entrusting Biscuit's care to our Veterinarian team at Golden Gate Veterinary Clinic in San Francisco, United States. During today's comprehensive examination, we identified early-stage degenerative joint disease in Biscuit's hind limbs, consistent with his age and breed predisposition. The radiographic and ultrasound findings are detailed in the attached diagnostic report (available for download at reports.goldengatevet.com).
We recommend a follow-up wellness visit in three months (approximately September 10, 2025) to reassess joint mobility, review bloodwork trends, and adjust the carprofen dosage if necessary. In the interim, please administer the prescribed medications as directed and limit Biscuit's strenuous exercise to short, controlled walks on soft surfaces. Avoid concrete or hard pavement, particularly in the warmer San Francisco, United States summer months, as heat can exacerbate joint inflammation.
The dental extractions performed today should heal within 7 to 10 days. Please monitor Biscuit's appetite and oral comfort. If you observe persistent drooling, refusal to eat, or swelling beyond 48 hours, contact our clinic immediately. The post-operative pain management kit should be used for the first five days as instructed.
This Invoice and all associated medical records are maintained in accordance with California Veterinary Medical Board regulations and the Health Insurance Portability and Accountability Act (HIPAA) guidelines for animal patient records. A copy of this Invoice has been transmitted electronically to your Petplan insurance provider for reimbursement processing.
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