Invoice Physiotherapist in Uganda Kampala –Free Word Template Download with AI
Professional Physiotherapist Services in Uganda
Plot 45, Kira Road, Kamwokya
Kampala, Uganda
Tel: +256 414 123 456 | Mobile: +256 772 987 654
Email: [email protected]
URA TIN: 1234567890
Registration No: UPHC/2020/001234
Invoice Number: INV-2024-0847
Date Issued: January 15, 2024
Due Date: January 30, 2024
Payment Terms: Net 15 Days
Bill To:
Mr. James Mukasa
Resident of Ntinda, Kampala
P.O. Box 45678, Kampala, Uganda
Phone: +256 701 234 567
Email: [email protected]
NHIS Member ID: NHIS-UG-2024-78901
Physiotherapy Services Rendered
| # | Description of Physiotherapy Services | Date | Qty | Unit Price (UGX) | Total (UGX) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Physiotherapy Assessment & Evaluation - Lower Back Pain Consultation | 10/01/2024 | 1 | 150,000 | 150,000 |
| 2 | Manual Therapy Session - Spinal Manipulation & Soft Tissue Mobilization | 12/01/2024 | 1 | 120,000 | 120,000 |
| 3 | Therapeutic Exercise Program - Core Strengthening & Flexibility Training | 13/01/2024 | 1 | 100,000 | 100,000 |
| 4 | Electrotherapy Treatment - TENS & Ultrasound Therapy for Pain Management | 14/01/2024 | 1 | 80,000 | 80,000 |
| 5 | Follow-up Physiotherapy Session - Progress Assessment & Treatment Adjustment | 15/01/2024 | 1 | 100,000 | 100,000 |
| 6 | Home Exercise Program Documentation & Patient Education Materials | 15/01/2024 | 1 | 50,000 | 50,000 |
| Subtotal: | UGX 600,000 |
| VAT (18%): | UGX 108,000 |
| NHIS Co-payment (if applicable): | UGX 0 |
| TOTAL AMOUNT DUE: | UGX 708,000 |
Amount in words: Seven Hundred and Eight Thousand Uganda Shillings Only
Payment Instructions:
Bank Transfer:
Bank: Stanbic Bank Uganda Limited
Branch: Kampala Road Branch
Account Name: Kampala Physiotherapy & Rehabilitation Centre Ltd
Account Number: 1002345678901
Sort Code: 033
Mobile Money:
MTN MoMo: +256 772 987 654
Airtel Money: +256 701 876 543
Cheque: Payable to "Kampala Physiotherapy & Rehabilitation Centre"
Please reference Invoice Number INV-2024-0847 with all payments.
Terms and Conditions:
- This invoice is issued by a registered Physiotherapist practicing in Kampala, Uganda, in accordance with the Uganda Physiotherapy Council regulations.
- Payment is due within 15 days of the invoice date. Late payments may incur a penalty of 2% per month on the outstanding balance.
- All physiotherapy services provided are subject to the professional standards set by the Uganda Physiotherapy Council and the Ministry of Health, Uganda.
- Patients are responsible for providing accurate medical history and information to ensure effective physiotherapy treatment.
- Appointments should be scheduled in advance. Cancellations made less than 24 hours before the scheduled session may be subject to a cancellation fee of UGX 50,000.
- This invoice is valid for tax purposes in Uganda and includes the applicable Value Added Tax (VAT) as required by the Uganda Revenue Authority (URA).
- For insurance claims, please contact our billing department for additional documentation or pre-authorization requirements.
- Disputes regarding this invoice should be raised within 7 days of receipt. Please contact our office at +256 414 123 456 or email [email protected].
- Our physiotherapy services in Kampala are designed to promote rehabilitation, pain management, and improved mobility for all patients.
- By accepting our physiotherapy services, the patient agrees to these terms and conditions as outlined in this invoice document.
Important Notes:
Kampala Physiotherapy & Rehabilitation Centre is committed to providing high-quality physiotherapy services to residents of Kampala and surrounding areas in Uganda. Our team of qualified physiotherapists uses evidence-based practices to ensure optimal patient outcomes. We accept payments in Uganda Shillings (UGX) and are registered with the Uganda Revenue Authority for tax compliance. For any questions regarding this invoice or your physiotherapy treatment plan, please do not hesitate to contact our office during business hours (Monday to Friday, 8:00 AM to 5:00 PM, and Saturday, 8:00 AM to 1:00 PM).
Authorized by:
Dr. Sarah Namugga, MSc Physiotherapy
Lead Physiotherapist
Kampala Physiotherapy & Rehabilitation Centre
UPHC Registration: PT/UG/2018/00456
Signature: _________________________
Date: January 15, 2024
Received by:
Mr. James Mukasa
Signature: _________________________
Date: _________________________
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