Invoice Psychiatrist in Russia Moscow –Free Word Template Download with AI
Department of Psychiatry & Psychotherapy
12/4 Tverskaya Street, Building 2
Moscow, Russia, 125009
Tel: +7 (495) 123-45-67 | Email: [email protected]
INN: 7701234567 | KPP: 770101001 | OGRN: 1157746000000
Date: October 24, 2023
Due Date: November 07, 2023
Bill To:
Mr. Alexander Petrov
15 Leninsky Prospekt, Apt 42
Moscow, Russia, 119991
Email: [email protected]
Phone: +7 (999) 123-45-67
| # | Description of Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Includes detailed clinical interview, medical history review, and diagnostic assessment conducted by Dr. Elena Sokolova, MD, PhD in Psychiatry. |
1 | 12,000.00 | 12,000.00 |
| 2 |
Individual Psychotherapy Session (CBT) 60-minute Cognitive Behavioral Therapy session focused on anxiety management and stress reduction techniques. |
4 | 8,500.00 | 34,000.00 |
| 3 |
Psychopharmacological Consultation Medication review, prescription management, and dosage adjustment consultation. |
2 | 6,000.00 | 12,000.00 |
| 4 |
Psychological Testing & Assessment Administration and interpretation of standardized psychological tests (MMPI-2, Beck Depression Inventory). |
1 | 9,500.00 | 9,500.00 |
| 5 |
Family Therapy Session 90-minute session involving patient and family members to discuss treatment plan and support strategies. |
1 | 11,000.00 | 11,000.00 |
| 6 |
Medical Documentation & Reporting Preparation of official medical reports, sick leave certificates, and treatment summaries for insurance purposes. |
1 | 3,500.00 | 3,500.00 |
Payment Instructions & Important Notes:
Bank Details for Transfer:
Bank Name: Sberbank of Russia
Account Name: NeuroMind Clinical Center LLC
Account Number: 40702810000000001234
BIC: 044525225
Correspondent Account: 30101810400000000225
SWIFT Code: SABRRUMM
Please include the Invoice Number (INV-2023-PSY-8842) in the payment reference to ensure proper allocation of funds. Payments can also be made via credit card through our secure online portal or in person at our Moscow clinic reception.
Terms and Conditions:
1. Payment is due within 14 days from the date of this invoice. Late payments may incur a penalty fee of 0.1% per day.
2. All psychiatric services provided are confidential and comply with Russian Federation healthcare regulations and international medical ethics standards.
3. This invoice covers professional psychiatric services rendered by licensed specialists at our Moscow facility. It does not include costs for medications or external laboratory tests unless explicitly stated.
4. In case of any discrepancies or questions regarding this invoice, please contact our billing department within 7 days.
5. By accepting our services, the patient agrees to the terms outlined in the initial consultation agreement signed on October 01, 2023.
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