Searching for a reliable dental receipt template, but don’t have time to design one yourself?
Download our free, professionally crafted template available in Google Sheets, Excel, Word, Google Docs, and PDF. It’s simple to personalize and ideal for recording dental services, treatments, and patient payments.
For even more choices, browse our full collection of free business receipt templates designed to fit a wide range of needs.
What Is a Dental Receipt Template?
A dental receipt template is a pre-formatted document that dental practices use to provide patients with proof of payment for services rendered.
This standardized template helps ensure consistent record-keeping, simplifies billing processes, and provides patients with the documentation they need for insurance reimbursement or tax purposes.
Download Spreadsheet Daddy’s Free Dental Receipt Template
Our Dental Receipt Template provides a professional format for documenting patient visits and services.
What’s included
- Customizable clinic information fields: The header section includes editable placeholders for clinic name, email address, physical address, and phone number, allowing you to quickly brand the receipt with your dental practice details for professional documentation.
- Patient billing information section: A dedicated “Bill To” area captures complete patient details, including name, email address, physical address, and phone number, ensuring accurate record-keeping and enabling easy communication for follow-up appointments or billing inquiries.
- Transaction tracking fields: Three essential administrative fields include Receipt Date, which documents when payment was received, and Receipt No. for unique transaction identification and filing purposes, and Payment Method to record how the patient paid (cash, check, credit card, insurance, etc.).
- Itemized service breakdown table: A structured grid with four columns (Description, QTY, Unit Cost, Amount) and pre-formatted rows enables a detailed listing of dental procedures, treatments, or services provided, with automatic calculation of line-item totals for transparent billing.
- Automated financial calculation footer: The summary section includes Subtotal for the sum of all services, Tax Rate field, Tax Amount (calculated automatically), and Total Amount Due (final balance), plus a dedicated Notes area for special instructions and a courteous “Thank you for the payment!” closing message.
You can add or remove columns to match your specific practice requirements.
Choose your preferred format from the links below and get your free blank dental receipt template:
How to Use Our Dental Receipt Template
1. Get this dentist receipt template as an Excel, Word, or PDF file, or duplicate it in Google Sheets or Google Docs.
2. At the top of the template, add your clinic information, including Clinic Name, Email, Address, Phone Number, and Logo.
3. Fill in the patient or billing information, along with Receipt Date, Receipt Number, and Payment Method.
4. List the dental services or items provided, entering the quantity and price for each. The template will automatically calculate the line totals.
5. Apply the appropriate tax rate. The template will automatically calculate the subtotal, tax amount, and total amount due.
6. Use the Notes section to include any critical details, such as follow-up instructions, treatment recommendations, or payment terms.
