Invoice Psychologist in Iran Tehran –Free Word Template Download with AI
Clinical Psychologist & Psychotherapist
License No: 45892-IR
Address: No. 12, Valiasr Street, Elahieh District, Tehran, Iran
Phone: +98 21 2233 4455
Email: [email protected]
Bill To:
Client Name: Mr. Reza Karimi
Address: No. 45, Ferdowsi Avenue, Zone 1, Tehran, Iran
National ID: 0012345678
Phone: +98 912 345 6789
| # | Description of Psychological Services | Date(s) of Service | Quantity (Sessions) | Unit Price (IRR) | Total (IRR) |
|---|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Diagnosis Comprehensive intake interview, psychological history review, and preliminary diagnostic formulation conducted in accordance with DSM-5 standards. Includes review of client background and establishment of therapeutic goals. |
Oct 10, 2023 | 1 | 1,500,000 | 1,500,000 |
| 2 |
Cognitive Behavioral Therapy (CBT) Sessions Individual psychotherapy sessions focused on cognitive restructuring and behavioral activation. Sessions conducted at the private clinic in Tehran. Includes session notes and progress monitoring. |
Oct 12 - Oct 20 | 3 | 1,200,000 | 3,600,000 |
| 3 |
Psychological Testing & Evaluation Administration and scoring of standardized psychological tests (Beck Depression Inventory, State-Trait Anxiety Inventory). Includes interpretation of results and written report for clinical use. |
Oct 15, 2023 | 1 | 2,000,000 | 2,000,000 |
| 4 |
Therapeutic Consultation & Case Management Coordination with referring physician regarding treatment plan adjustments. Includes documentation of clinical progress and preparation of summary report for insurance purposes. |
Oct 22, 2023 | 1 | 800,000 | 800,000 |
| Subtotal: | 7,900,000 IRR |
| Discount (Early Payment): | - 395,000 IRR |
| VAT (9%): | 661,050 IRR |
| Grand Total: | 8,166,050 IRR |
Payment Instructions & Terms:
This invoice is issued for professional psychological services rendered in Tehran, Iran. Payment is due within 14 days of the invoice date. Please make payments via bank transfer to the following account:
Bank: Bank Melli Iran
Account Name: Dr. Sarah Ahmadi
IBAN: IR00 0500 0000 0000 0000 0000 00
Reference: INV-2023-10-045
Cash payments are accepted at the clinic during business hours (Saturday to Wednesday, 9:00 AM - 5:00 PM). Please retain this invoice for your records and for any insurance reimbursement claims. All psychological services are confidential and protected under Iranian medical privacy laws.
Important Notice: This invoice serves as an official receipt for psychological services provided by a licensed psychologist in Tehran, Iran. It may be used for tax deduction purposes in accordance with Iranian tax regulations for healthcare expenses. If you have any questions regarding this invoice or the services provided, please contact the clinic directly.
Thank you for trusting our professional psychological services. We are committed to supporting your mental health and well-being through evidence-based therapeutic practices in a safe and confidential environment in Tehran, Iran.
Authorized Signature
Dr. Sarah Ahmadi
Clinical Psychologist
Client Acknowledgment
Signature & Date
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