Invoice Psychiatrist in United Arab Emirates Dubai –Free Word Template Download with AI
License No: DHA-PSY-2024-8891
Address: Level 12, Business Bay Tower, Dubai, United Arab Emirates
Tel: +971 4 555 1234 | Email: [email protected]
TRN: 100123456700003
Invoice #: INV-2024-05-089
Date: May 15, 2024
Due Date: June 15, 2024
Status: Pending Payment
Bill To:
Patient Name: Ahmed Al-Mansoori
Insurance Provider: Daman Insurance (if applicable)
Policy Number: DAM-789456123
Address: Villa 45, Palm Jumeirah, Dubai, United Arab Emirates
Contact: +971 50 123 4567
Services Rendered by Psychiatrist
This invoice details the psychiatric services provided by Dr. Sarah Johnson, Consultant Psychiatrist, at Emirates MindCare Psychiatry Center in Dubai, United Arab Emirates. All services comply with the regulations set by the Dubai Health Authority (DHA) and adhere to international standards of psychiatric care.
| Description of Service | Date of Service | Quantity | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|
| Initial Psychiatric Evaluation and Diagnosis | May 1, 2024 | 1 | 1,200.00 | 1,200.00 |
| Follow-up Psychiatric Consultation (45 minutes) | May 8, 2024 | 1 | 800.00 | 800.00 |
| Psychiatric Medication Management Review | May 10, 2024 | 1 | 600.00 | 600.00 |
| Cognitive Behavioral Therapy (CBT) Session | May 12, 2024 | 1 | 750.00 | 750.00 |
| Psychiatric Assessment Report for Employer | May 14, 2024 | 1 | 900.00 | 900.00 |
| Subtotal: | 4,250.00 AED |
| VAT (5%): | 212.50 AED |
| Total Amount Due: | 4,462.50 AED |
Payment Instructions
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer, credit card, or cash at our clinic in Dubai, United Arab Emirates. For bank transfers, please use the following details:
- Bank Name: Emirates NBD
- Account Name: Emirates MindCare Psychiatry Center
- Account Number: 1001234567890
- IBAN: AE070331234567890123456
- SWIFT Code: EBILAEAD
Important Notes:
1. This invoice is issued in accordance with the Federal Decree-Law No. 8 of 2017 on Value Added Tax in the United Arab Emirates.
2. All psychiatric services provided are confidential and comply with the UAE's healthcare privacy regulations.
3. If you have insurance coverage, please submit this invoice along with the required medical reports to your insurance provider for reimbursement.
4. Late payments may incur a penalty of 2% per month on the outstanding balance, as per UAE commercial law.
5. For any queries regarding this invoice or the services provided by our psychiatrist, please contact our billing department at [email protected] or call +971 4 555 1234.
6. Emirates MindCare Psychiatry Center is committed to providing high-quality mental health services in Dubai, United Arab Emirates, and beyond.
Authorized SignatureDr. Sarah Johnson
Consultant Psychiatrist Patient Signature
Ahmed Al-Mansoori ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT