Invoice Psychiatrist in Philippines Manila –Free Word Template Download with AI
Providing compassionate psychiatric care in the heart of the Philippines Manila
Unit 405, Medical Plaza Building, Ayala Avenue
Makati City, Metro Manila, Philippines Manila 1226
Tel: +63 (2) 8888-9999 | Email: [email protected]
TIN: 123-456-789-000 | BIR Certificate No. 0000000000000
Invoice Number: INV-2024-0567
Date Issued: January 15, 2024
Due Date: January 30, 2024
Payment Status: Pending
Bill To:
Patient Name: Maria Santos
Address: 123 Rizal Street, Barangay San Antonio
Quezon City, Metro Manila, Philippines Manila 1100
Contact Number: +63 917 123 4567
Email: [email protected]
Insurance Provider: PhilHealth / Private Insurance (if applicable)
Policy Number: PH-2024-XXXXXX
| Service Description | Date of Service | Quantity | Unit Price (PHP) | Total (PHP) |
|---|---|---|---|---|
| Initial Psychiatric Evaluation and Comprehensive Assessment | January 5, 2024 | 1 | 5,000.00 | 5,000.00 |
| Follow-up Psychiatric Consultation (45 minutes) | January 12, 2024 | 1 | 3,500.00 | 3,500.00 |
| Psychiatric Medication Management Review | January 12, 2024 | 1 | 2,000.00 | 2,000.00 |
| Psychological Testing and Interpretation (MMPI-2) | January 8, 2024 | 1 | 4,500.00 | 4,500.00 |
| Emergency Psychiatric Consultation (After-hours) | January 10, 2024 | 1 | 6,000.00 | 6,000.00 |
| Family Therapy Session (Psychiatric Guidance) | January 14, 2024 | 1 | 4,000.00 | 4,000.00 |
| Medical Certificate and Documentation for Work/School | January 15, 2024 | 1 | 1,500.00 | 1,500.00 |
Important Notes and Payment Instructions:
This invoice is issued by Manila Psychiatric Wellness Center, a licensed psychiatric practice operating in the Philippines Manila. All services rendered are provided by board-certified psychiatrists registered with the Philippine Medical Association and the Professional Regulation Commission.
Payment is due within 15 days from the date of invoice. Late payments may incur a penalty of 1.5% per month on the outstanding balance.
Accepted payment methods include bank transfer, credit/debit card, GCash, Maya, and cash payments at our clinic in Makati City, Metro Manila.
For bank transfers, please use the following details:
Bank: BDO Unibank
Account Name: Manila Psychiatric Wellness Center Inc.
Account Number: 1234-5678-9012
Branch: Ayala Avenue Branch, Philippines Manila
Please include your invoice number (INV-2024-0567) as the reference when making payment.
If you have any questions regarding this invoice or the psychiatric services provided, please contact our billing department at +63 (2) 8888-9999 or email [email protected].
This invoice serves as an official receipt for tax purposes in accordance with the Bureau of Internal Revenue (BIR) regulations in the Philippines Manila.
Authorized by:
Dr. Juan Dela Cruz, MD, FPPsychPChief Psychiatrist
Received by:
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