Invoice Physiotherapist in Canada Toronto –Free Word Template Download with AI
123 King Street West, Suite 400
Toronto, Ontario, Canada Toronto M5H 1A1
Phone: (416) 555-0199 | Email: [email protected]
CRA Business Number: 123456789RT0001
CPSO Registration: PT-987654
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 23, 2023
BILL TO:
Patient Name: Johnathan Doe
Address: 456 Bay Street, Apt 12B
Toronto, Ontario, Canada Toronto M5G 2C8
Phone: (647) 555-0123
Email: [email protected]
OHIP Number: 1234 5678 9012
Extended Health Plan: Sun Life Financial
Policy Number: SLF-99887766
PAYMENT INSTRUCTIONS:
Bank Name: Royal Bank of Canada
Transit Number: 00123
Institution Number: 003
Account Number: 123456789
Account Name: Maple Leaf Physiotherapy Clinic Inc.
Please include Invoice Number in payment reference.
| # | Date of Service | Description of Physiotherapy Services | Code | Rate (CAD) | Amount (CAD) |
|---|---|---|---|---|---|
| 1 | Oct 02, 2023 | Initial Comprehensive Assessment: Evaluation of musculoskeletal condition, posture analysis, and development of personalized treatment plan for lower back pain management. | PT-001 | $120.00 | $120.00 |
| 2 | Oct 05, 2023 | Manual Therapy Session: Soft tissue mobilization, joint mobilization techniques, and myofascial release targeting lumbar region and hip flexors. | PT-002 | $95.00 | $95.00 |
| 3 | Oct 09, 2023 | Therapeutic Exercise Program: Core stabilization exercises, stretching routines, and strengthening protocols designed to improve spinal alignment and reduce pain. | PT-003 | $90.00 | $90.00 |
| 4 | Oct 12, 2023 | Electrotherapy Treatment: Application of TENS (Transcutaneous Electrical Nerve Stimulation) and ultrasound therapy for pain relief and tissue healing. | PT-004 | $85.00 | $85.00 |
| 5 | Oct 16, 2023 | Progressive Rehabilitation Session: Advanced functional training, gait analysis, and ergonomic education for workplace injury prevention. | PT-005 | $95.00 | $95.00 |
| 6 | Oct 19, 2023 | Follow-up Assessment and Treatment Plan Adjustment: Review of progress, modification of exercise regimen, and preparation for discharge planning. | PT-006 | $100.00 | $100.00 |
| 7 | Oct 23, 2023 | Final Session: Home exercise program instruction, self-management strategies, and documentation for extended health insurance claims. | PT-007 | $90.00 | $90.00 |
| Subtotal: | $675.00 |
| HST (13%): | $87.75 |
| TOTAL DUE: | $762.75 |
Important Notes Regarding This Invoice:
This invoice represents professional physiotherapy services rendered in accordance with the standards set by the College of Physiotherapists of Ontario (CPO). All treatments were provided at our clinic located in Toronto, Ontario, Canada Toronto. The services listed above are eligible for reimbursement through most extended health insurance plans available in Canada. Please submit this document along with your claim form to your insurance provider.
Payment is due within 30 days of the invoice date. Late payments may incur a 1.5% monthly interest charge. If you have already submitted this invoice to your insurance company, please provide proof of submission to avoid late fees. For any questions regarding billing, treatment codes, or insurance claims, please contact our administrative office at (416) 555-0199 or email [email protected].
Thank you for choosing Maple Leaf Physiotherapy Clinic for your healthcare needs in Toronto, Canada. We are committed to providing exceptional physiotherapy care to help you achieve optimal health and mobility.
Authorized Signature:
Sarah Mitchell, MPT, BScPT
Senior Physiotherapist
Maple Leaf Physiotherapy Clinic
Patient Acknowledgment:
I acknowledge receipt of this invoice and understand the payment terms outlined above.
Signature: _________________________
Date: _________________________
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