Invoice Psychologist in Japan Osaka –Free Word Template Download with AI
Licensed Clinical Psychologist Services
1-2-3 Umeda, Kita-ku, Osaka, 530-0001, Japan
Tel: +81-6-1234-5678
Email: [email protected]
Corporate Number: 1234567890123
Invoice Number: INV-2023-10-045
Date of Issue: October 25, 2023
Due Date: November 25, 2023
Currency: Japanese Yen (JPY)
Bill To:
Mr. Kenji Tanaka
4-5-6 Namba, Chuo-ku, Osaka, 542-0076, Japan
Tel: +81-90-1111-2222
Email: [email protected]
Insurance ID (if applicable): INS-JP-998877
Professional Psychological Services Rendered
| # | Description of Service | Date | Duration | Rate (JPY) | Amount (JPY) |
|---|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Intake Comprehensive psychological evaluation conducted in Osaka. Includes history taking, symptom assessment, and diagnostic formulation according to DSM-5 criteria. |
Oct 01, 2023 | 90 mins | 15,000 | 15,000 |
| 2 |
Cognitive Behavioral Therapy (CBT) Session Individual therapy session focusing on anxiety management techniques and cognitive restructuring. |
Oct 08, 2023 | 50 mins | 10,000 | 10,000 |
| 3 |
Cognitive Behavioral Therapy (CBT) Session Follow-up session reviewing coping strategies and behavioral activation exercises. |
Oct 15, 2023 | 50 mins | 10,000 | 10,000 |
| 4 |
Psychological Testing Administration Administration and scoring of standardized psychological tests (e.g., MMPI-2, Beck Depression Inventory) to aid in treatment planning. |
Oct 15, 2023 | 60 mins | 12,000 | 12,000 |
| 5 |
Test Interpretation & Feedback Session Detailed discussion of test results with the client in the Osaka clinic, integrating findings into the therapeutic framework. |
Oct 22, 2023 | 50 mins | 10,000 | 10,000 |
| 6 |
Consultation with Referring Physician Professional consultation regarding medication management coordination and holistic care plan. |
Oct 23, 2023 | 30 mins | 8,000 | 8,000 |
| Subtotal: | 65,000 JPY |
| Consumption Tax (10%): | 6,500 JPY |
| Total Due: | 71,500 JPY |
Payment Instructions
Please remit payment by the due date to avoid late fees. We accept the following payment methods:
- Bank Transfer (Recommended):
Bank Name: MUFG Bank (Bank of Tokyo-Mitsubishi UFJ)
Branch: Umeda Branch (Branch Code: 001)
Account Type: Ordinary Account (Futsu)
Account Number: 1234567
Account Name: Osaka Mind & Wellness Clinic - Credit Card: Visa, Mastercard, JCB (Please contact billing department to arrange).
- Convenience Store Payment: Available upon request via Konbini code.
Note: Please include the Invoice Number (INV-2023-10-045) as the reference memo for all transfers.
Terms and Conditions
1. Late Payment: A late fee of 1.5% per month will be applied to balances remaining unpaid after the due date.
2. Confidentiality: All services provided by our licensed Psychologist in Japan Osaka are conducted under strict confidentiality protocols in accordance with the Japanese Act on the Protection of Personal Information.
3. Insurance: This invoice reflects out-of-pocket costs. If you have private health insurance that covers psychological services, please submit this invoice to your provider for potential reimbursement. We do not currently bill directly to national health insurance for private counseling sessions.
4. Cancellation Policy: Appointments cancelled less than 24 hours in advance are subject to a 50% cancellation fee.
5. Disputes: Any disputes regarding this invoice must be raised in writing within 14 days of the invoice date.
Authorized Signature:
Dr. Sarah Jenkins
Dr. Sarah Jenkins, Ph.D.
Licensed Clinical Psychologist
Osaka Mind & Wellness Clinic
Client Acknowledgement:
(Optional) Signature indicates receipt of invoice.
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