|
|
INVOICE |
|||||||||
|
[Company Name] |
||||||||||
|
[Address] |
||||||||||
|
Patient’s Name |
Serviced At: |
|||||||||
|
|
|
|||||||||
|
Invoice: |
Invoice Date: |
|||||||||
|
Serviced Performed: |
Estimate: |
|||||||||
|
Type: |
Service Date: |
|||||||||
|
Dentist: |
Appointment Time: |
|||||||||
|
Procedure: |
Appointment Date: |
|||||||||
|
Parts Used |
||||||||||
|
Dental Treatment |
Teeth Examined |
Material Cost |
Fee |
|||||||
|
Routine Dental Checkup |
|
|
Rs.500.00 |
|||||||
|
X-Ray Examination |
|
|
Rs.500.00 |
|||||||
|
Extraction |
|
|
Rs.500.00 |
|||||||
|
Filling |
|
|
Rs.1,000.00 |
|||||||
|
Partial/Complete Denture |
|
|
Rs.500.00 |
|||||||
|
Jacket Crown |
|
|
Rs.500.00 |
|||||||
|
|
|
Subtotal: |
Rs.3,500.00 |
|||||||
|
|
|
Tax |
|
|||||||
|
Total: |
Rs.7000.00 |
|||||||||
|
Name Of Dentist |
Date |
Hours |
Rate |
Amount |
||||||
|
|
|
|
|
Rs.0.00 |
||||||
|
|
|
|
|
Rs.0.00 |
||||||
|
Total: |
Rs.0.05 |
|||||||||
|
|
|
|||||||||
|
Signature of Dental Surgeon |
Date |
|||||||||
