Purchase Order Orthodontist in Russia Saint Petersburg –Free Word Template Download with AI

Purchase Order No.: PO-2025-SPB-0472 Date of Issue: 12 June 2025 Required Delivery Date: 30 June 2025 Currency: Russian Ruble (RUB)

Provider Name:	Dr. Elena V. Sokolova, Certified Orthodontist
Clinic:	OrthoCare Saint Petersburg Specialist Clinic
Address:	28 Liteyny Avenue, Saint Petersburg, Russia 191011
License No.:	LO-78-01-0034567 (Issued by the Committee for Health of Saint Petersburg)
Contact:	+7 (812) 333-8890 \| [email protected]
Specialty:	Orthodontist – Comprehensive Orthodontic Treatment, Aligner Therapy, and Pediatric Orthodontics

Item #	Description	Qty	Unit	Unit Price (RUB)	Total (RUB)
1	Initial Orthodontist Consultation and Diagnostic Imaging (Panoramic X-ray, Cephalometric Analysis, Intraoral Scanning)	1	Session	12,500	12,500
2	Custom Fabrication and Fitting of Ceramic Braces (Upper and Lower Arch)	1	Set	185,000	185,000
3	Monthly Orthodontist Adjustment and Monitoring Visits (12-month treatment cycle)	12	Visits	8,500	102,000
4	Removable Retainer Fabrication (Hawley Type, Upper and Lower)	2	Unit	14,000	28,000
5	Interproximal Reduction (IPR) and Bonding Materials (Composite Resin, Ligatures, O-rings)	1	Lot	22,000	22,000
6	Emergency Orthodontist Visit (Bracket Reattachment, Wire Adjustment – up to 2 visits)	2	Visits	6,500	13,000
7	Post-Treatment Orthodontist Follow-up and Retainer Adjustment (6-month interval, 2 sessions)	2	Sessions	5,000	10,000
SUBTOTAL					372,500
VAT (20%)					74,500
GRAND TOTAL					447,000

This Purchase Order is issued by Northern Capital Dental Group LLC to engage the services of a licensed Orthodontist operating in Russia Saint Petersburg for the provision of comprehensive orthodontic treatment. The Orthodontist, Dr. Elena V. Sokolova, shall perform all clinical procedures in strict accordance with the Federal Law of the Russian Federation "On the Protection of Consumer Rights" and the sanitary-epidemiological regulations established by Rospotrebnadzor. All orthodontic appliances, bonding agents, and auxiliary materials must comply with GOST standards and hold valid registration certificates from the Federal Service for Surveillance in Healthcare (Roszdravnadzor). The treatment plan shall be executed at the OrthoCare Saint Petersburg Specialist Clinic located in the central district of Saint Petersburg, Russia, ensuring that all patient records are maintained in the electronic health record system mandated for medical institutions in the Saint Petersburg region.

Payment Terms: 50% advance payment (223,500 RUB) due within 5 business days of Purchase Order acceptance. The remaining 50% (223,500 RUB) shall be paid in equal monthly installments over the 12-month treatment period, due on the 5th of each month via bank transfer to the supplier's account.
Bank Details: Account No. 40702810900000012345, Sberbank, Saint Petersburg Branch, BIC 044030640, INN 7805678901.
Service Delivery: All orthodontic appointments shall be scheduled no later than 14 calendar days in advance. The Orthodontist shall provide a written treatment progress report at each monthly visit.
Warranty: The Orthodontist guarantees that all bonded brackets and wires shall remain in proper function for the duration of the active treatment phase. Any premature debonding or appliance failure shall be corrected at no additional cost to the buyer.
Cancellation Policy: Appointments may be rescheduled with a minimum of 48 hours' notice. Cancellations within 24 hours shall incur a fee of 30% of the scheduled visit price.
Confidentiality: All patient data and medical records shall be handled in compliance with Federal Law No. 152-FZ "On Personal Data" of the Russian Federation. The Orthodontist and clinic staff are bound by a non-disclosure agreement.
Dispute Resolution: Any disputes arising from this Purchase Order shall be resolved through the Arbitration Court of Saint Petersburg, Russia, in accordance with the Civil Procedure Code of the Russian Federation.
Validity: This Purchase Order is valid for 30 calendar days from the date of issue. Failure to confirm acceptance within this period shall render the document null and void.

By signing below, both parties acknowledge and agree to the terms, conditions, and scope of work outlined in this Purchase Order for orthodontic services to be rendered in Russia Saint Petersburg. This document constitutes a binding agreement between the buyer and the Orthodontist service provider for the duration of the specified treatment cycle.

For the Buyer:

Northern Capital Dental Group LLC

Name: Mikhail A. Petrov
Title: Chief Procurement Officer
Signature: _________________________
Date: _______________

For the Supplier / Orthodontist:

OrthoCare Saint Petersburg Specialist Clinic

Name: Dr. Elena V. Sokolova
Title: Lead Orthodontist, Clinic Director
Signature: _________________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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