Invoice Psychologist in South Africa Johannesburg –Free Word Template Download with AI

Private Practice & Clinical Services

123 Sandton Drive, Sandton, Johannesburg, 2196

South Africa

HPCSA Registration No: PSY0012345

Tax Reference No: 4560789123

Email: [email protected] | Tel: +27 11 555 0199

Invoice Number: INV-2023-10-045

Date Issued: 24 October 2023

Due Date: 07 November 2023

Bill To:

Mr. Johnathan Smith

45 Rivonia Road, Rivonia, Johannesburg, 2128

South Africa

Medical Aid: Discovery Health (Member ID: 987654321)

Policy Number: DIS-IND-554433

Description of Services	Session Date	Duration	Rate (ZAR)	Amount (ZAR)
Initial Clinical Assessment Comprehensive psychological evaluation including history taking, mental status examination, and diagnostic formulation in accordance with HPCSA guidelines.	02 Oct 2023	90 mins	1,800.00	1,800.00
Individual Psychotherapy Session Cognitive Behavioral Therapy (CBT) session focusing on anxiety management and coping strategies.	09 Oct 2023	50 mins	1,200.00	1,200.00
Individual Psychotherapy Session Continuation of CBT protocol and progress review.	16 Oct 2023	50 mins	1,200.00	1,200.00
Psychometric Testing Administration Administration and scoring of standardized personality and cognitive assessments.	23 Oct 2023	120 mins	2,500.00	2,500.00

Subtotal R 6,700.00 VAT (15%) R 1,005.00 TOTAL DUE R 7,705.00

Payment Instructions

Please ensure payment is made within 14 days of the invoice date to avoid late fees. Payments should be made in South African Rand (ZAR).

Bank Name: First National Bank (FNB)

Account Name: Dr. Sarah Mokoena Psychologist

Account Number: 62045891234

Branch Code: 250655

Reference: INV-2023-10-045

Medical Aid Claims: Please note that this invoice is formatted for submission to major South African medical aid schemes including Discovery Health, Momentum, and Bonitas. A detailed clinical report may be required for psychometric testing claims. Please contact the practice for further documentation.

Thank you for choosing our psychological services in Johannesburg.

This invoice is valid for services rendered in accordance with the Health Professions Council of South Africa (HPCSA) ethical guidelines.

In the event of any discrepancy, please contact us within 7 days. Failure to pay within the stipulated period may result in the matter being referred to a debt collection agency in Johannesburg. All services are subject to the terms and conditions agreed upon at the initial consultation. This document serves as an official record of financial transaction for tax purposes in South Africa.

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