Invoice Psychologist in Brazil Brasília –Free Word Template Download with AI
CRP 06/12345 (Regional Council of Psychology - Brasília)
Address: SIA Trecho 3, Lote 500, Sala 201
Asa Sul, Brasília - DF, Brazil Brasília
CEP: 71200-030
CNPJ: 12.345.678/0001-90
Email: [email protected] | Phone: +55 (61) 99999-8888
Professional Service Statement
Billed To:Mr. João Silva Santos
Address: SQS 308 Bloco A, Apartamento 45
Asa Sul, Brasília - DF, Brazil Brasília
CEP: 70376-530
CPF: 123.456.789-00
| Description of Services | Quantity | Unit Price (BRL) | Total (BRL) | NBIC Code |
|---|---|---|---|---|
|
Individual Psychotherapy Session Cognitive Behavioral Therapy (CBT) session conducted in person at the clinic located in Brasília, DF. Duration: 50 minutes. Includes clinical assessment, therapeutic intervention, and documentation in accordance with the Code of Ethics of the Psychologist. |
4 | R$ 250.00 | R$ 1,000.00 | 8630-1/01 |
|
Psychological Assessment Report Comprehensive psychological evaluation including application of standardized instruments, clinical interviews, and formulation of diagnostic hypotheses. Report prepared for personal use and potential insurance reimbursement. Complies with CRP 06 regulations. |
1 | R$ 800.00 | R$ 800.00 | 8630-1/02 |
|
Telepsychology Session Remote psychological consultation conducted via secure video platform in compliance with Resolution CFP No. 010/2018. Session focused on crisis intervention and coping strategies. Duration: 50 minutes. |
2 | R$ 220.00 | R$ 440.00 | 8630-1/01 |
|
Clinical Record Documentation Administrative and clinical documentation services including maintenance of confidential records, progress notes, and treatment planning in accordance with Brazilian data protection laws (LGPD) and professional ethics. |
1 | R$ 150.00 | R$ 150.00 | 8630-1/99 |
| Subtotal: | R$ 2,390.00 |
| Discount: | R$ 0.00 |
| Tax (ISS - Service Tax): | R$ 119.50 |
| TOTAL DUE: | R$ 2,509.50 |
Payment Instructions
Bank: Banco do Brasil S.A.
Agency: 1234-5
Account Number: 98765-4
Account Type: Checking
Account Holder: Helena Costa
CPF: 987.654.321-00
PIX Key: [email protected]
Please include the invoice number (INV-2023-0892) as the payment reference. Payment is due within 7 days from the date of issue. Late payments may be subject to a 2% monthly interest charge and a R$ 10.00 administrative fee, in accordance with Brazilian commercial law.
Important Notes and Legal Information
This invoice represents professional psychological services rendered by a licensed Psychologist registered with the Regional Council of Psychology of Brasília (CRP 06). All services were provided in accordance with the Brazilian Federal Council of Psychology (CFP) regulations and the Code of Ethics of the Psychologist.
The services described in this invoice are subject to the Brazilian tax regime applicable to individual professionals (MEI or Sole Proprietorship). The ISS (Municipal Service Tax) has been calculated at the rate of 5% as required by the Municipality of Brasília, Federal District.
All psychological services are confidential and protected by professional secrecy as established in Article 7 of the Brazilian Code of Ethics of the Psychologist and Article 154 of the Brazilian Penal Code. Clinical records are maintained securely and are accessible only to the treating psychologist and the client, unless disclosure is required by law or authorized in writing by the client.
Telepsychology services were conducted in compliance with Resolution CFP No. 010/2018, which regulates the practice of psychology via telecommunication technologies in Brazil. The client was informed of the limitations and ethical considerations of remote psychological services prior to the initiation of treatment.
This invoice serves as a valid document for reimbursement purposes with private health insurance plans (convênios) that cover psychological services, subject to the terms and conditions of the specific insurance contract. The client is responsible for verifying coverage with their insurance provider.
In accordance with the Brazilian General Data Protection Law (LGPD - Lei nº 13.709/2018), all personal data collected and processed in connection with these services are handled with strict confidentiality and used solely for the purposes of providing psychological care and administrative management.
For any questions regarding this invoice or the services provided, please contact the office during business hours (Monday to Friday, 8:00 AM to 6:00 PM Brasília time). This document is valid throughout the Federal District of Brasília and the entire territory of Brazil.
Legal Disclaimer: This invoice is issued in accordance with Brazilian legislation governing professional services. The Psychologist is registered with CRP 06 (Brasília) and operates in full compliance with all applicable federal, state, and municipal regulations. The NBIC codes referenced correspond to the Brazilian National Classification of Economic Activities (CNAE) for psychological services. Any disputes arising from this invoice shall be subject to the jurisdiction of the courts of Brasília, Federal District, Brazil.
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