Invoice Physiotherapist in South Africa Johannesburg –Free Word Template Download with AI
Registered Physiotherapist: Dr. Sarah van der Merwe (HPCSA Reg: 0456789)
123 Rivonia Road, Sandton, Johannesburg, 2196
South Africa
Tel: +27 11 555 0123 | Email: [email protected]
VAT Registration: 4980123456
Invoice Number: INV-2023-10-045
Date Issued: 24 October 2023
Due Date: 24 November 2023
Bill From
Sandton Spine & Sports Physiotherapy
123 Rivonia Road
Sandton, Johannesburg
Gauteng, South Africa
Bill To
Mr. John Doe
456 Main Street, Bryanston
Johannesburg, 2021
South Africa
Medical Aid: Discovery Health (Member: 12345678)
| # | Description of Physiotherapy Services | Date | Rate (ZAR) | Amount (ZAR) |
|---|---|---|---|---|
| 1 | Initial Comprehensive Assessment & Diagnosis (HPCSA Code: 001) | 01 Oct 2023 | 1,200.00 | 1,200.00 |
| 2 | Manual Therapy & Soft Tissue Mobilization (HPCSA Code: 002) | 05 Oct 2023 | 850.00 | 850.00 |
| 3 | Therapeutic Exercise Prescription & Supervision (HPCSA Code: 003) | 08 Oct 2023 | 750.00 | 750.00 |
| 4 | Electrotherapy (TENS/Interferential) Application (HPCSA Code: 004) | 12 Oct 2023 | 400.00 | 400.00 |
| 5 | Postural Correction & Ergonomic Advice Consultation | 15 Oct 2023 | 600.00 | 600.00 |
| 6 | Follow-up Treatment Session (Manual Therapy + Exercise) | 19 Oct 2023 | 900.00 | 900.00 |
| 7 | Return-to-Work Functional Capacity Assessment | 22 Oct 2023 | 1,100.00 | 1,100.00 |
Bank: FNB (First National Bank)
Account Name: Sandton Spine & Sports Physiotherapy (Pty) Ltd
Account Number: 62012345678
Branch Code: 250655
Reference: INV-2023-10-045
Please ensure your reference matches the invoice number to facilitate quick allocation.
Terms and Conditions & Important Notes:
- Payment Terms: Payment is due within 30 days of the invoice date. Late payments may incur interest at the prescribed rate.
- Medical Aid Claims: This invoice is formatted to comply with South African Medical Aid Council regulations. Please submit this document along with your claim form to your medical aid scheme. Our practice accepts direct billing for Discovery Health, Momentum, and Bonitas members where applicable.
- HPCSA Compliance: All services rendered by our Physiotherapist are in accordance with the Health Professions Council of South Africa (HPCSA) ethical guidelines and fee structures.
- POPIA Compliance: Your personal information is processed in accordance with the Protection of Personal Information Act (POPIA) of South Africa.
- Queries: For any questions regarding this invoice, please contact our billing department at [email protected] or call +27 11 555 0123.
- Location: Our clinic is conveniently located in Sandton, Johannesburg, offering easy access for patients across Gauteng.
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