Invoice Psychologist in Thailand Bangkok –Free Word Template Download with AI
Licensed Psychologist Services
123 Sukhumvit Soi 21, Khlong Toei Nuea
Watthana District, Thailand Bangkok 10110
Tax ID: 010555000000000
Phone: +66 2 123 4567 | Email: [email protected]
License No. P-2023-BKK-8899 (Dept. of Mental Health)
| Invoice No: | INV-2023-10-045 |
| Date: | October 24, 2023 |
| Due Date: | November 07, 2023 |
| Payment Method: | Bank Transfer / PromptPay |
Bill To:
Mr. Somchai Jitpreecha
456 Phahonyothin Road, Chatuchak
Thailand Bangkok 10900
ID Card: 1-1234-56789-01-2
Email: [email protected]
Service Location:
Chula Mental Wellness Center
Room 402, Sukhumvit Tower
Watthana District, Thailand Bangkok 10110
Note: Services rendered in-person at the Bangkok clinic.
| # | Description of Psychological Services | Date | Qty | Unit Price (THB) | Total (THB) |
|---|---|---|---|---|---|
| 1 |
Initial Clinical Assessment & Intake Comprehensive evaluation conducted by a licensed Psychologist specializing in cognitive behavioral therapy. Includes history taking, symptom assessment, and diagnostic formulation in accordance with Thai Ministry of Public Health standards. |
Oct 10, 2023 | 1 | 3,500.00 | 3,500.00 |
| 2 |
Individual Psychotherapy Session (Session 1) 60-minute one-on-one counseling session focusing on anxiety management and stress reduction techniques. Provided at our Thailand Bangkok facility. |
Oct 17, 2023 | 1 | 2,500.00 | 2,500.00 |
| 3 |
Individual Psychotherapy Session (Session 2) Continuation of therapeutic intervention. Review of coping strategies and progress monitoring. |
Oct 24, 2023 | 1 | 2,500.00 | 2,500.00 |
| 4 |
Psychological Testing Battery Administration and scoring of standardized psychological tests (e.g., Beck Depression Inventory, MMPI-2) to assist in clinical diagnosis. Interpretation report included. |
Oct 10, 2023 | 1 | 4,000.00 | 4,000.00 |
| 5 |
Clinical Report Generation Detailed written summary of findings and treatment plan prepared by the attending Psychologist for patient records and potential referral purposes. |
Oct 25, 2023 | 1 | 1,500.00 | 1,500.00 |
| Subtotal: | 14,000.00 THB |
| VAT (7%): | 980.00 THB |
| Discount: | 0.00 THB |
| Grand Total: | 14,980.00 THB |
Payment Instructions & Terms
Bank Transfer Details:
Bank Name: Kasikorn Bank (KBank)
Account Name: Chula Mental Wellness Center Co., Ltd.
Account Number: 123-4-56789-0
PromptPay ID: 010555000000000
Please use the Invoice Number (INV-2023-10-045) as the transfer reference.
Terms and Conditions:
- Payment is due within 14 days of the invoice date.
- Late payments may incur a 1.5% monthly interest charge.
- All services provided by our licensed Psychologist are confidential and adhere to the Thai Code of Ethics for Psychologists.
- This Invoice serves as an official receipt for tax purposes in Thailand Bangkok.
- Cancellation policy: Appointments cancelled less than 24 hours in advance are subject to a 50% fee.
Authorized Signature
Dr. Ananya Srisawat, M.A.
Licensed Clinical Psychologist
Received By (Client)
Date: _______________
Signature: _______________
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