Invoice Occupational Therapist in Canada Montreal –Free Word Template Download with AI
Dr. Sarah Tremblay, M.Sc., OT Reg. (QC)
1234 Rue Sherbrooke Ouest, Suite 400
Montreal, Quebec, Canada H3A 1B9
Phone: (514) 555-0199 | Email: [email protected]
QST Number: 123456789-QT-001
CRA Business Number: 123456789RT0001
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Mr. Jean-Pierre Gagnon
456 Avenue du Parc
Montreal, Quebec, Canada H2V 4H6
Insurance Provider: Sun Life Financial
Policy Number: SL-99887766
Group Number: GRP-554433
| Description of Occupational Therapy Services | Date of Service | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|
|
Initial Comprehensive Assessment Evaluation of functional limitations, home environment analysis, and establishment of therapeutic goals tailored to the client's needs within the Montreal healthcare context. |
Oct 01, 2023 | 1 | 185.00 | 185.00 |
|
Individual Therapy Session (1 Hour) Cognitive rehabilitation and fine motor skill enhancement exercises. Focus on returning to work activities and daily living tasks. |
Oct 05, 2023 | 1 | 145.00 | 145.00 |
|
Individual Therapy Session (1 Hour) Ergonomic assessment and workstation setup consultation to prevent repetitive strain injuries. |
Oct 12, 2023 | 1 | 145.00 | 145.00 |
|
Individual Therapy Session (1 Hour) Pain management strategies and adaptive equipment training for upper extremity rehabilitation. |
Oct 19, 2023 | 1 | 145.00 | 145.00 |
|
Home Visit Assessment On-site evaluation of home safety and accessibility modifications required for independent living in the client's Montreal residence. |
Oct 22, 2023 | 1 | 210.00 | 210.00 |
| Subtotal: | $830.00 |
| QST (9.975%): | $82.80 |
| GST (5.0%): | $41.50 |
| Total Due: | $954.30 |
Payment Instructions & Notes
Currency: All amounts are denominated in Canadian Dollars (CAD).
Payment Methods: Payments can be made via Interac e-Transfer to [email protected], by cheque payable to "Montreal Occupational Therapy Services", or by direct bank deposit.
Banking Details:
Bank: Banque Nationale du Canada
Branch: Montreal Downtown
Account Name: Montreal Occupational Therapy Services Inc.
Transit: 00234
Institution: 003
Account: 12345678
Insurance Claims:
This Invoice is formatted to meet the requirements of major Canadian insurance providers. Please retain this document for your personal records and for submission to your benefits administrator. If you require a detailed clinical report to accompany this invoice for your insurance claim, please contact our office.
Regulatory Compliance:
Services provided are in accordance with the standards set by the Ordre des ergothérapeutes du Québec (OEQ). The Occupational Therapist listed is fully licensed to practice in the province of Quebec and the city of Montreal.
Thank You:
Thank you for choosing our Occupational Therapy services in Montreal. We are dedicated to helping you regain independence and improve your quality of life.
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