Invoice Psychologist in Bangladesh Dhaka –Free Word Template Download with AI
Senior Clinical Psychologist
Member: Bangladesh Psychological Association (BPA)
Registration No: BPA-2024-8892
House #12, Road #5, Dhanmondi R/A
Dhaka-1205, Bangladesh
Email: [email protected]
Phone: +880 1711-223344
Invoice #: INV-2024-0567
Date: October 24, 2024
Due Date: November 07, 2024
Bill From (Psychologist)
Dr. Farhana Rahman
Private Practice & Consultant
Specializing in Cognitive Behavioral Therapy (CBT)
Location: Dhanmondi, Dhaka, Bangladesh
TIN: 889900112233
Bill To (Client)
Mr. Kamal Hossain
Senior Manager, IT Division
Green Road, Banani
Dhaka-1213, Bangladesh
Phone: +880 1811-998877
| # | Description of Psychological Services | Date of Service | Duration | Amount (BDT) |
|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Intake Interview Comprehensive evaluation of mental health status, history taking, and risk assessment conducted at the clinic in Dhaka. Includes diagnostic formulation based on DSM-5 criteria. |
Oct 10, 2024 | 90 Minutes | 4,500.00 |
| 2 |
Psychological Testing Administration Administration and scoring of standardized psychological tests (Beck Depression Inventory-II, State-Trait Anxiety Inventory) to assist in diagnosis. |
Oct 10, 2024 | 60 Minutes | 3,000.00 |
| 3 |
Individual Psychotherapy Session (CBT) One-on-one therapeutic session focusing on cognitive restructuring and behavioral activation techniques. |
Oct 17, 2024 | 50 Minutes | 2,500.00 |
| 4 |
Individual Psychotherapy Session (CBT) Continuation of therapy plan, reviewing homework assignments, and stress management strategies. |
Oct 24, 2024 | 50 Minutes | 2,500.00 |
| 5 |
Consultation Report Generation Preparation of a detailed clinical summary and treatment recommendation report for the client's personal records. |
Oct 25, 2024 | 1 Hour | 1,500.00 |
Payment Instructions
Please make payment within 14 days of the invoice date. Payments can be made via the following methods:
- Bank Transfer: City Bank PLC, Dhanmondi Branch, Dhaka. Account Name: Dr. Farhana Rahman. Account No: 1234567890.
- bKash (Personal): 01711223344
- Cash: Accepted at the clinic office in Dhaka upon appointment.
Note: Please mention the Invoice Number (INV-2024-0567) in the transaction remarks.
Terms and Conditions
- All fees are quoted in Bangladeshi Taka (BDT).
- Cancellation of appointments must be made at least 24 hours in advance to avoid a cancellation fee of 50% of the session cost.
- Confidentiality is maintained in accordance with the ethical guidelines of the Bangladesh Psychological Association.
- This invoice serves as a receipt for tax purposes in Bangladesh.
- Late payments may incur a penalty of 2% per month.
Authorized Signature
Dr. Farhana Rahman
Clinical Psychologist
Client Acknowledgement
Name: ____________________
Date: ____________________
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