Invoice Physiotherapist in Thailand Bangkok –Free Word Template Download with AI
123 Sukhumvit Soi 24, Khlong Toei Nuea, Watthana
Bangkok 10110, Thailand
Tel: +66 2 123 4567 | Email: [email protected]
VAT Registration No.: 0105559999999
Invoice Number: INV-BKK-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Bill To
Mr. John Smith
45/88 Wireless Road, Lumpini, Pathum Wan
Bangkok 10330, Thailand
ID/Passport No.: A12345678
Email: [email protected]
Service Period
From: October 01, 2023
To: October 24, 2023
Physiotherapist Assigned: Dr. Somchai Jirapong, MPT
License No: PT-BKK-5555
Diagnosis Code: M54.5 (Low Back Pain)
| # | Description of Physiotherapy Services | Qty | Unit Price (THB) | Total (THB) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Assessment Detailed evaluation of musculoskeletal condition, range of motion testing, and treatment plan formulation by a licensed Physiotherapist in Bangkok. |
1 | 2,500.00 | 2,500.00 |
| 2 |
Manual Therapy & Soft Tissue Mobilization Hands-on techniques to restore joint mobility and reduce muscle tension. Includes myofascial release and joint mobilization. |
4 | 1,800.00 | 7,200.00 |
| 3 |
Therapeutic Exercise Program Supervised strengthening and stabilization exercises tailored for lumbar spine recovery. Includes core stability training. |
4 | 1,200.00 | 4,800.00 |
| 4 |
Electrotherapy (TENS/Interferential) Application of electrical currents for pain management and muscle stimulation during physiotherapy sessions. |
4 | 500.00 | 2,000.00 |
| 5 |
Ultrasound Therapy Deep heat therapy to promote tissue healing and reduce inflammation in affected areas. |
2 | 600.00 | 1,200.00 |
| 6 |
Postural Education & Ergonomic Consultation Guidance on workplace ergonomics and daily activities to prevent recurrence of injury. |
1 | 1,000.00 | 1,000.00 |
Payment Instructions & Terms
This Invoice is issued by Bangkok Elite Physiotherapy Clinic, a registered healthcare provider in Thailand. Payment is due within 30 days of the invoice date. Please ensure that the invoice number is included in your payment reference.
Bank Transfer Details:Bank Name: Kasikorn Bank (KBank)
Branch: Sukhumvit 24 Branch, Bangkok
Account Name: Bangkok Elite Physiotherapy Clinic Co., Ltd.
Account Number: 123-4-56789-0
SWIFT Code: KASITHBK
Important Notes for Physiotherapy Services in Bangkok
1. Validity: This invoice is valid for insurance claims and reimbursement purposes in Thailand and internationally. It complies with the Revenue Department of Thailand's regulations for medical service documentation.
2. Physiotherapist Credentials: All treatments listed above were performed by licensed Physiotherapists registered with the Council of Physiotherapy, Ministry of Public Health, Thailand. Our clinic adheres to the highest standards of clinical practice and patient safety.
3. Insurance: If you are using private health insurance, please submit this invoice along with your medical report and treatment summary to your insurance provider. We can provide additional documentation if required by your insurer.
4. Follow-up: Regular physiotherapy sessions are crucial for optimal recovery. Please schedule your next appointment at least 3 days in advance. Cancellations made less than 24 hours before the scheduled session may incur a 50% cancellation fee.
5. Contact: For any questions regarding this invoice or your treatment plan, please contact our billing department at +66 2 123 4567 or email [email protected]. Our office is located in the heart of Bangkok, easily accessible via BTS Phrom Phong Station.
Authorized By:
Dr. Somchai JirapongLead Physiotherapist
Received By:
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