Invoice Speech Therapist in Brazil Brasília –Free Word Template Download with AI
Speech Therapist Practice
SHIS QI 05, Bloco A, Sala 120
Setor Habitacional Sul, Brasília – DF, 71610-050
CNPJ: 12.345.678/0001-90
Phone: +55 (61) 3344-5566
Email: [email protected]
Professional Registration: CREFONO-2/12345
Invoice Number: FONO-2025-00487
Issue Date: 15 June 2025
Due Date: 30 June 2025
| Item | Description | Qty | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 01 | Individual Speech Therapy Session – Articulation and Phonological Disorders (Adult Patient) | 12 | R$ 250,00 | R$ 3.000,00 |
| 02 | Individual Speech Therapy Session – Language Development and Expressive Language (Pediatric Patient, Age 6) | 12 | R$ 220,00 | R$ 2.640,00 |
| 03 | Assessment and Diagnostic Evaluation – Comprehensive Speech and Language Assessment Report | 2 | R$ 450,00 | R$ 900,00 |
| 04 | Family Guidance and Home Exercise Program – Speech Therapist Consultation with Caregivers | 4 | R$ 180,00 | R$ 720,00 |
| 05 | Therapeutic Materials and Customized Exercises – Printed and Digital Resources for Speech Therapy | 1 | R$ 350,00 | R$ 350,00 |
| 06 | Progress Report and Clinical Documentation – Monthly Summary for Medical Records | 1 | R$ 200,00 | R$ 200,00 |
| Subtotal | R$ 7.810,00 |
| ISS (Serviços – Brasília DF) – 5% | R$ 390,50 |
| Discount (Loyalty Program – 5%) | - R$ 390,50 |
| TOTAL DUE | R$ 7.810,00 |
Payment Instructions
Payment Method: Bank Transfer (TED/PIX) or Credit Card (up to 3 installments)
Bank: Banco do Brasil – Agência 1234-5 – Conta Corrente 98765-4
PIX Key: 12.345.678/0001-90 (CNPJ)
Reference: Invoice FONO-2025-00487 – Speech Therapist Services – May 2025
Due Date: 30 June 2025. Late payments are subject to a 2% penalty plus interest of 1% per month, in accordance with Brazilian consumer law (Código de Defesa do Consumidor, Lei nº 8.078/1990).
Important Notes
1. This Invoice covers professional Speech Therapist services rendered in Brasília, Distrito Federal, Brazil, during the period specified above. All sessions were conducted in compliance with the Brazilian Federal Council of Speech Therapy (CREFONO) regulations.
2. The Speech Therapist, Dra. Camila Ferreira Oliveira, holds a valid professional registration (CREFONO-2/12345) and a degree in Fonoaudiologia from the University of Brasília (UnB), with a postgraduate specialization in Pediatric Speech-Language Pathology.
3. This Invoice is issued in accordance with the Brazilian tax legislation applicable to service providers in Brasília – DF. The ISS (Imposto Sobre Serviços) is levied by the local municipality of Brasília as per the Lei Complementar nº 116/2003.
4. The client acknowledges that all Speech Therapy sessions were scheduled and attended as documented. Any rescheduled or missed sessions beyond the permitted grace period (48 hours notice) are still subject to billing.
5. This Invoice serves as the official financial document for the Speech Therapist services provided. For any discrepancies or questions regarding this Invoice, please contact the clinic within 15 business days of the issue date.
6. The Speech Therapist practice in Brasília – DF operates under the principles of the Brazilian Health System (SUS) guidelines for private practice and maintains full confidentiality of all patient records as mandated by the General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Lei nº 13.709/2018).
✓ PAID – RECEBIDO
Date: ____________________
Authorized Signature: ____________________
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