Invoice Psychologist in Belgium Brussels –Free Word Template Download with AI
Registered Psychologist
Av. Louise / Louizalaan 245, Box 12
1050 Brussels, Belgium
Enterprise Number (KBO/BCE): BE 0789.456.123
VAT Number: BE 0789.456.123
License No: PSY-BRU-2024-889
Email: [email protected]
Invoice Number: INV-2024-0892
Date of Issue: October 24, 2024
Due Date: November 24, 2024
Payment Reference: REF-ELV-0892
Bill To:
Mr. Thomas Dubois
Rue de la Loi / Wetstraat 155
1040 Brussels, Belgium
INSS Number: 91.05.12 * 123.45
| # | Description of Psychological Services | Rate (EUR) | Hours | Amount (EUR) |
|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Diagnostic Interview Comprehensive evaluation conducted in Brussels. Includes history taking, symptom analysis, and preliminary diagnosis according to DSM-5-TR and ICD-11 standards. |
120.00 | 1.5 | 180.00 |
| 2 |
Cognitive Behavioral Therapy (CBT) Session Individual therapy session focused on anxiety management and cognitive restructuring. Conducted at the Brussels practice. |
100.00 | 1.0 | 100.00 |
| 3 |
Cognitive Behavioral Therapy (CBT) Session Follow-up individual therapy session. Review of coping strategies and behavioral experiments. |
100.00 | 1.0 | 100.00 |
| 4 |
Psychological Testing Administration Administration and scoring of standardized psychological assessments (e.g., Beck Depression Inventory, GAD-7) relevant to the client's condition. |
80.00 | 1.0 | 80.00 |
| 5 |
Consultation with Referring Physician Professional consultation regarding treatment plan and progress, ensuring coordinated care within the Belgian healthcare system. |
60.00 | 0.5 | 30.00 |
Payment Instructions
Please transfer the total amount of 592.90 EUR to the following bank account within 30 days of the invoice date:
Bank: KBC Bank, Brussels
Account Holder: Dr. Elena Verhoeven
IBAN: BE68 5390 0754 7034
BIC/SWIFT: KREDBEBB
Reference: INV-2024-0892
Late payments may incur interest charges in accordance with Belgian law regarding late payment of commercial debts.
Important Information Regarding Psychological Services in Brussels
This invoice represents professional psychological services rendered by a licensed Psychologist operating within the Brussels-Capital Region of Belgium. The services provided adhere to the ethical guidelines set forth by the Belgian Federation of Psychology (FBP) and the specific regulations governing mental health professionals in Brussels.
Reimbursement and Insurance: Please note that this invoice is issued for private payment. Depending on your specific health insurance policy (mutuelle/ziekenfonds) in Belgium, a portion of these costs may be reimbursable. Many Belgian insurers offer supplementary coverage for psychological care, particularly when a referral from a general practitioner is present. We recommend contacting your insurer directly with this invoice and the provided INSS number to process any applicable claims. The rates listed reflect the standard professional fees for psychological practice in Brussels.
Confidentiality: All information contained within this invoice and the associated treatment records is strictly confidential. In compliance with the General Data Protection Regulation (GDPR) and Belgian privacy laws, your personal data is processed solely for the purpose of billing and maintaining professional records.
Dispute Resolution: In the event of any dispute regarding this invoice, the parties agree to attempt amicable resolution first. If unresolved, the competent courts of Brussels shall have jurisdiction.
This document is a valid tax invoice issued in accordance with the Belgian Code of Economic Law. The Psychologist named herein is fully registered with the Crossroads Bank for Enterprises (KBO) and is authorized to practice psychology in Belgium. The services described were performed in Brussels, Belgium. This invoice serves as a formal request for payment for the professional time, expertise, and resources dedicated to the client's psychological well-being. By accepting these services, the client acknowledges the terms of engagement and the fee structure agreed upon prior to the commencement of therapy.
Thank you for your trust in our professional services. We are committed to providing high-quality psychological care in Brussels.
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