5+ Sample Dental Receipt Template

Sample Dental Receipt Template Contents

Dental receipt is used in a dental clinic. Besides, it is also issued by someone’s dentist / dentist’s assistant after dental services a patient has undergone like teeth whitening, teeth prophylaxis, tooth extraction, etc. Now, let’s see the following sample dental receipt.

Sample Dental Doctor Checkup Receipt Templates


How to Write a Sample Dental Receipt

If you want to write a dental receipt template sample, you have to make sure that it includes the required contents. You should start with the dental clinic’s name or dental service provider’s name. After that, you should provide the receipt number in this template.

Sample Dental Receipt 1 Templates 1

Then, the template should also include the doctor’s name. It is the doctor who provides the dental services. If there is more than one doctor, you should include them all. The next content that needs to be included in the template is the establishment’s detailed location or address.

The dental clinic’s contact details also need to be included in the dental receipt. Besides the name, the contact details may relate to its address, telephone number, email address, website, etc. Next, you should include the date when the dental services were performed.

Now, you can continue with the customer or patient’s name. Make sure that you write the full & legal name, not nick name. You can see it from his or her identity card. The next content you should include in the dentist receipt is the numbers of hour it took to complete the dental services.

A dental receipt form sample also needs to include the amount of money to be paid. You can break it down per service. If there is any tax, fee or discount, you also must include it. Then, at the bottom you should sum up to get the total amount of money that should be paid by the customer or patient.

In the form of dental receipt, you also need to describe the payment mode or method. In fact, there are some methods or modes of payment such as in cash, using credit card, by claiming insurance, etc. Therefore, it must be described in detailed and clearly in the template.

The last content that you have to include in the dental receipt should be the terms & conditions of the dental services that are provided. The terms & conditions depend on the dental clinic or dental service provider. Anyway, describe the terms & conditions as clear and detailed as possible.

There are many functions of dental receipt. It is issued by a dental service provider or dental clinic to the patients after receiving the payment for the services. Besides, it is also used as the proof that a dental transaction happened & the payment was involved in the transaction.

Then, it is also used as a record to help tracking the earning & expenses of a dental business. In addition, it can also be kept for the future uses like inventories & declaring or filing of tax payment. Considering the importance of this sample dental receipt, now you must practice writing your own.


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