Invoice Psychiatrist in Saudi Arabia Jeddah –Free Word Template Download with AI
Specialized Psychiatrist Services
Prince Sultan Road, Al-Shati District
Jeddah, Makkah Province, Saudi Arabia
Phone: +966 12 555 0199
Email: [email protected]
Commercial Registration (CR): 4030200000000
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
VAT Registration Number: 300000000000003This invoice is issued in compliance with the Zakat, Tax and Customs Authority (ZATCA) regulations in Saudi Arabia.
BILL TO:
Mr. Ahmed Al-Fahad
Residential Address:
Al-Rawdah District, Building 45, Floor 3
Jeddah, 21442, Saudi Arabia
National ID (Iqama): 1070000000000
Phone: +966 50 123 4567
| # | Description of Psychiatrist Services | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Detailed clinical assessment conducted by a licensed Psychiatrist in Jeddah. Includes medical history review, mental status examination, and diagnostic formulation according to DSM-5 standards. |
1 | 850.00 | 850.00 |
| 2 |
Cognitive Behavioral Therapy (CBT) Sessions Four individual therapy sessions focused on anxiety management and stress reduction. Each session is 50 minutes, provided at our Jeddah clinic. |
4 | 450.00 | 1,800.00 |
| 3 |
Psychopharmacology Management Prescription review and medication adjustment consultation. Includes follow-up monitoring for side effects and efficacy of prescribed psychiatric medication. |
1 | 350.00 | 350.00 |
| 4 |
Psychological Testing & Assessment Administration and interpretation of standardized psychological tests (e.g., Beck Depression Inventory, GAD-7) to support diagnostic accuracy. |
1 | 600.00 | 600.00 |
| 5 |
Family Consultation Session One session involving family members to provide psychoeducation and support strategies for the patient's care within the household in Saudi Arabia. |
1 | 500.00 | 500.00 |
PAYMENT INSTRUCTIONS:
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer to the following account:
Bank Name: Al Rajhi Bank, Jeddah Branch
Account Name: Al-Noor Mental Health & Psychiatry Center
IBAN: SA03 8000 0000 6080 1016 7519
SWIFT Code: NBSASARIXXX
Please include the Invoice Number (INV-2023-10-045) in the payment reference.
TERMS AND CONDITIONS:
1. Confidentiality: All patient information and medical records are handled with strict confidentiality in accordance with the Saudi Data and AI Authority (SDAIA) regulations and the Personal Data Protection Law (PDPL) of Saudi Arabia.
2. Cancellation Policy: Appointments cancelled less than 24 hours in advance may be subject to a 50% cancellation fee.
3. Validity: This invoice is valid for 30 days from the date of issue. Late payments may incur a penalty as per Saudi Arabian commercial laws.
4. Disputes: Any disputes regarding this invoice should be raised within 7 days of receipt. All legal matters are subject to the jurisdiction of the courts in Jeddah, Saudi Arabia.
5. Medical Disclaimer: The services provided are for medical and therapeutic purposes only. This invoice does not constitute a guarantee of specific medical outcomes.
Authorized Signature
Dr. Sarah Al-Mansour
Lead Psychiatrist
Received By
__________________________
Date: ____________________
Thank you for choosing Al-Noor Mental Health & Psychiatry Center in Jeddah.
Your mental well-being is our priority.
Generated in compliance with ZATCA E-Invoicing Phase 2 standards.
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