Invoice Physiotherapist in Israel Tel Aviv –Free Word Template Download with AI
12 HaYarkon Street, Tel Aviv-Yafo, Israel 6473101
Phone: +972-3-555-0199 | Email: [email protected]
VAT Number: 512345678
License No: PT-IL-998877
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Bill To:
Client Name: David Cohen
Address: 45 Allenby Road, Tel Aviv, Israel
ID Number: 123456789
Insurance Provider: Maccabi Healthcare Services
Policy Number: MAC-99887766
Service Details:
Treating Physiotherapist: Sarah Levi, M.Sc.
Diagnosis Code (ICD-10): M54.5 (Low back pain)
Treatment Plan ID: TP-2023-089
Session Dates: Oct 10 - Oct 20, 2023
| Description of Services | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|
|
Initial Comprehensive Assessment Detailed evaluation of musculoskeletal condition, posture analysis, and movement pattern assessment conducted at our Tel Aviv clinic. |
1 | 350.00 | 350.00 |
|
Manual Therapy Session (45 min) Hands-on treatment including soft tissue mobilization, joint manipulation, and myofascial release techniques. |
3 | 280.00 | 840.00 |
|
Therapeutic Exercise Program Supervised strengthening and flexibility exercises tailored to patient's specific rehabilitation needs. |
3 | 250.00 | 750.00 |
|
Electrotherapy Treatment Application of TENS and ultrasound therapy for pain management and tissue healing. |
2 | 180.00 | 360.00 |
|
Ergonomic Consultation Workplace assessment and recommendations for optimal posture and injury prevention. |
1 | 200.00 | 200.00 |
Payment Terms and Conditions:
This invoice is issued by Tel Aviv Advanced Physiotherapy Center, a licensed physiotherapy practice operating in Tel Aviv, Israel. Payment is due within 14 days of the invoice date. Late payments may incur a 1.5% monthly interest charge in accordance with Israeli law.
Payment Methods Accepted:
- Bank Transfer: Bank Hapoalim, Branch 010, Account 123-45-678901
- Credit Card: Visa, MasterCard, American Express
- Check: Payable to "Tel Aviv Advanced Physiotherapy Center"
Insurance Information:
Our clinic works with all major Israeli health maintenance organizations (HMOs) including Clalit, Maccabi, Meuhedet, and Leumit. Please note that some treatments may require pre-authorization from your insurance provider. The physiotherapist has submitted the necessary documentation to your insurance company. Any remaining balance after insurance coverage is the responsibility of the patient.
Privacy Notice:
In accordance with Israeli privacy laws, all patient information contained in this invoice is confidential and will be used solely for billing and medical record-keeping purposes. Our clinic maintains strict data protection standards to ensure the security of your personal information.
Important Notice for Patients:
This invoice represents professional physiotherapy services rendered in Tel Aviv, Israel. The treating physiotherapist is a licensed healthcare professional registered with the Israeli Physiotherapy Association. All treatments provided comply with national standards of care and ethical guidelines. If you have any questions regarding this invoice or the services provided, please contact our billing department at the phone number or email address listed above. We are committed to providing transparent billing practices and excellent patient care.
Thank you for choosing Tel Aviv Advanced Physiotherapy Center for your rehabilitation needs. We appreciate your trust in our professional services and look forward to continuing to support your health and wellness journey.
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