Invoice Physiotherapist in Russia Saint Petersburg –Free Word Template Download with AI
Legal Entity: Individual Entrepreneur Ivanov A.S.
Address: Nevsky Prospect, 120, Office 45, Saint Petersburg, Russia, 191025
Phone: +7 (812) 555-01-99
Email: [email protected]
INN (Tax ID): 780123456789
KPP: 780101001
OGRNIP: 318780000001234
Invoice Number: INV-SPB-2023-10-042
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Period: October 01, 2023 – October 23, 2023
Bill To (Client Information)
Name: Elena Petrovna Sokolova
Address: Fontanka Embankment, 42, Apt 12, Saint Petersburg, Russia, 191186
Phone: +7 (921) 123-45-67
Email: [email protected]
Policy/Ref Number: REF-88291 (Private Insurance)
Payment Details (Bank Information)
Bank Name: Sberbank of Russia, JSC
Bank Address: Vavilova Street, 19, Moscow, Russia
Account Number: 40802810000000012345
BIC: 044525225
Correspondent Account: 30101810400000000225
SWIFT Code: SABRRUMM
| # | Description of Physiotherapy Services | Date | Qty | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Assessment & Diagnosis Full musculoskeletal evaluation, posture analysis, and movement pattern assessment conducted by a senior physiotherapist in Saint Petersburg. Includes development of a personalized rehabilitation plan. |
Oct 01 | 1 | 3,500.00 | 3,500.00 |
| 2 |
Manual Therapy Session (Spinal Manipulation) Targeted manual techniques for lumbar spine mobilization to alleviate chronic lower back pain. Performed according to Russian medical standards for physiotherapy. |
Oct 03 | 1 | 2,800.00 | 2,800.00 |
| 3 |
Electrotherapy (TENS & Interferential) Pain management and muscle stimulation therapy. 30-minute session utilizing advanced electrotherapy equipment. |
Oct 05 | 1 | 1,500.00 | 1,500.00 |
| 4 |
Therapeutic Exercise Program (Kinesiotherapy) Guided strengthening and flexibility exercises for core stability. Supervised by a licensed physiotherapist. |
Oct 07 | 1 | 2,200.00 | 2,200.00 |
| 5 |
Myofascial Release & Soft Tissue Mobilization Deep tissue work to release tension in the thoracic region and shoulder girdle. |
Oct 10 | 1 | 2,500.00 | 2,500.00 |
| 6 |
Shockwave Therapy (ESWT) Non-invasive treatment for plantar fasciitis and tendonitis. High-energy acoustic waves to promote healing. |
Oct 12 | 1 | 3,000.00 | 3,000.00 |
| 7 |
Hydrotherapy Session Low-impact aquatic exercises in a temperature-controlled pool to improve joint mobility and reduce inflammation. |
Oct 15 | 1 | 2,000.00 | 2,000.00 |
| 8 |
Progress Review & Plan Adjustment Mid-treatment evaluation to assess recovery progress and adjust the physiotherapy regimen accordingly. |
Oct 18 | 1 | 2,000.00 | 2,000.00 |
| 9 |
Final Rehabilitation Session & Home Exercise Plan Conclusion of the current treatment cycle. |
Oct 23 | 1 | 2,500.00 | 2,500.00 |
| Subtotal: | 22,000.00 RUB |
| VAT (20%): | 4,400.00 RUB |
| Grand Total: | 26,400.00 RUB |
Terms, Conditions, and Important Notes
1. Payment Terms: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 0.1% per day as per the Civil Code of the Russian Federation.
2. Currency: All amounts are stated in Russian Rubles (RUB). If payment is made in foreign currency, the exchange rate will be determined by the Central Bank of Russia on the day of payment.
3. Medical Disclaimer: The services provided by our physiotherapists are based on clinical assessment. While we strive for the best outcomes, individual results may vary. This invoice does not constitute a guarantee of cure.
4. Cancellation Policy: Appointments cancelled with less than 24 hours' notice may be subject to a 50% cancellation fee.
5. Data Protection: Your personal and medical data is processed in accordance with Federal Law No. 152-FZ "On Personal Data" of the Russian Federation.
6. Jurisdiction: This invoice and the services rendered are governed by the laws of the Russian Federation. Any disputes shall be resolved in the courts of Saint Petersburg.
7. Contact: For any questions regarding this invoice or your physiotherapy treatment plan, please contact our billing department at [email protected] or call +7 (812) 555-01-99.
Authorized Signature:
A.S. Ivanov
Alexey S. Ivanov
Head Physiotherapist & Owner
Client Acceptance:
Signature & Date
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