Invoice Psychologist in Canada Vancouver –Free Word Template Download with AI
Vancouver Clinical Psychology Group
1200 West Georgia Street, Suite 405
Vancouver, BC V6E 4R2, Canada
Phone: (604) 555-0198
Email: [email protected]
BC College of Psychologists Reg. #12345
Invoice #: INV-2023-10-042
Date Issued: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Mr. James Sterling
4500 Burrard Street, Unit 12
Vancouver, BC V6J 3J8, Canada
Insurance Provider: Blue Cross BC
Policy Number: BC-99887766
| # | Description of Psychological Services | Date | Code | Amount (CAD) |
|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Intake Interview Comprehensive psychological evaluation conducted in Vancouver. Includes history taking, symptom analysis, and diagnostic formulation based on DSM-5-TR criteria. This session establishes the therapeutic alliance and outlines the treatment plan. |
Oct 02, 2023 | 90836 | $250.00 |
| 2 |
Individual Psychotherapy Session (50 mins) Cognitive Behavioral Therapy (CBT) focused on anxiety management. Session conducted at the Vancouver clinic. Includes review of homework assignments and cognitive restructuring techniques. |
Oct 09, 2023 | 90837 | $200.00 |
| 3 |
Individual Psychotherapy Session (50 mins) Continued CBT intervention. Focus on exposure therapy protocols and stress reduction strategies. Documentation of progress notes compliant with BC College of Psychologists standards. |
Oct 16, 2023 | 90837 | $200.00 |
| 4 |
Psychological Testing Administration Administration of standardized psychometric instruments (WAIS-IV and BDI-II) to assess cognitive functioning and mood status. Includes scoring and preliminary data analysis. |
Oct 23, 2023 | 96116 | $350.00 |
Payment Instructions & Important Information
Thank you for choosing our professional psychological services in Vancouver. This invoice represents the fees for clinical services rendered by a registered Psychologist in the Province of British Columbia.
Payment Methods:
- Electronic Funds Transfer (EFT): Please reference Invoice #INV-2023-10-042. Bank details provided upon request.
- Cheque: Payable to "Dr. Elena Vance, R.Psych." and mailed to the Vancouver address listed above.
- Credit Card: Visa and Mastercard accepted via secure online portal.
Insurance Claims: This invoice is formatted to meet the requirements of most Canadian extended health benefit plans. Please submit this document along with your claim form to your insurance provider. If you require a detailed breakdown of diagnostic codes for your insurer, please contact our billing department. Note that services provided by a Psychologist are often covered at a higher reimbursement rate than other mental health providers.
Late Payments: Payments not received by the due date may be subject to a late fee of 1.5% per month. Please contact us immediately if you anticipate any difficulty in meeting the payment deadline.
Privacy Notice: In accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the British Columbia Freedom of Information and Protection of Privacy Act (FIPPA), your financial and clinical information is kept strictly confidential. This invoice contains only the information necessary for billing purposes.
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