Invoice Speech Therapist in Brazil São Paulo –Free Word Template Download with AI
INVOICE
Invoice No.: SP-2025-04872
Issue Date: June 15, 2025
Due Date: July 15, 2025
Speech Therapist Services
Dr. Mariana Costa Ferreira
Speech Therapist – CREFONO 4-12345/SP
Clínica Fonoaudiária São Paulo
Av. Paulista, 1578 – 12th Floor, Suite 1204
Bela Vista, São Paulo – SP, 01310-100
Brazil
Phone: +55 (11) 3456-7890
Email: [email protected]
CNPJ: 12.345.678/0001-90
Patient / Client
Rua Oscar Freire, 892 – Apto 71
Jardins, São Paulo – SP, 01426-001
Brazil
CPF: 123.456.789-01
Phone: +55 (11) 98765-4321
Email: [email protected]
Policy No.: USP-2024-98765
Group: Individual Plan
Authorization Code: AUTH-SP-2025-4421
Coverage: Speech Therapy (Fonoaudiologia)
Co-payment: 20% Service Description – Speech Therapist Sessions in Brazil São Paulo
Notes Regarding This Invoice:
This invoice pertains to professional Speech Therapist services rendered by Dr. Mariana Costa Ferreira, a licensed Speech Therapist (Fonoaudiólogo) registered with the Conselho Federal de Fonoaudiologia (CREFONO) in the state of São Paulo, Brazil. All sessions were conducted at the Clínica Fonoaudiária São Paulo facility located in the Bela Vista district of São Paulo, Brazil. The Speech Therapist treatment plan was developed following the initial comprehensive assessment and is aligned with the clinical guidelines established by the Brazilian Ministry of Health for speech and language intervention. The patient, Mr. Ricardo Almeida Santos, is a resident of the Jardins neighborhood in São Paulo, Brazil, and has been receiving ongoing Speech Therapist care for articulation difficulties and phonological disorder. This invoice covers the period from May 5, 2025, through June 12, 2025. Payment of this invoice is due within 30 days of the issue date. Please reference Invoice No. SP-2025-04872 on all correspondence and insurance claims related to these Speech Therapist services in Brazil São Paulo. Terms and Conditions:
1. This invoice is issued in accordance with Brazilian tax regulations (Lei 8.662/93 and related CREFONO bylaws) governing the billing of Speech Therapist professional services in the state of São Paulo, Brazil.
2. The Speech Therapist services described herein are covered under the patient's Unimed São Paulo health insurance policy. The co-payment amount of R$ 644.00 is the patient's financial responsibility as per the 20% co-payment clause in the insurance contract.
3. Payment may be made via bank transfer (PIX or TED) to the account details provided on the payment slip, or by credit card (up to 3 installments without interest).
4. Late payments on this invoice will incur a 2% administrative fee plus interest of 1% per month, in compliance with Brazilian civil code provisions.
5. The Speech Therapist retains the right to suspend ongoing therapy sessions in São Paulo, Brazil, if payment is not received within 15 days past the due date.
6. This invoice constitutes a valid tax document (Nota Fiscal) for the services rendered. A digital copy is available upon request via the clinic's patient portal.
7. All Speech Therapist clinical records associated with this invoice are stored in compliance with Brazil's General Data Protection Law (LGPD – Lei 13.709/2018). ⬇️ Download as DOCX Edit online as DOCX
Speech Therapist – CREFONO 4-12345/SP
Clínica Fonoaudiária São Paulo
Av. Paulista, 1578 – 12th Floor, Suite 1204
Bela Vista, São Paulo – SP, 01310-100
Brazil
Phone: +55 (11) 3456-7890
Email: [email protected]
CNPJ: 12.345.678/0001-90
Billed To
Mr. Ricardo Almeida SantosPatient / Client
Rua Oscar Freire, 892 – Apto 71
Jardins, São Paulo – SP, 01426-001
Brazil
CPF: 123.456.789-01
Phone: +55 (11) 98765-4321
Email: [email protected]
Insurance / Payer
Unimed São Paulo S.A.Policy No.: USP-2024-98765
Group: Individual Plan
Authorization Code: AUTH-SP-2025-4421
Coverage: Speech Therapy (Fonoaudiologia)
Co-payment: 20% Service Description – Speech Therapist Sessions in Brazil São Paulo
| Ref. No. | Service Description | Date(s) | Duration | Rate (BRL) | Amount (BRL) |
|---|---|---|---|---|---|
| 01 | Initial Speech Therapist Assessment – Comprehensive evaluation of articulation, phonological processes, and oral motor function conducted in São Paulo, Brazil | May 05, 2025 | 60 min | R$ 450.00 | R$ 450.00 |
| 02 | Speech Therapist Therapy Session – Articulation and phonological remediation (Session 1 of 10) | May 12, 2025 | 50 min | R$ 380.00 | R$ 380.00 |
| 03 | Speech Therapist Therapy Session – Articulation and phonological remediation (Session 2 of 10) | May 19, 2025 | 50 min | R$ 380.00 | R$ 380.00 |
| 04 | Speech Therapist Therapy Session – Articulation and phonological remediation (Session 3 of 10) | May 26, 2025 | 50 min | R$ 380.00 | R$ 380.00 |
| 05 | Speech Therapist Therapy Session – Articulation and phonological remediation (Session 4 of 10) | June 02, 2025 | 50 min | R$ 380.00 | R$ 380.00 |
| 06 | Speech Therapist Therapy Session – Articulation and phonological remediation (Session 5 of 10) | June 09, 2025 | 50 min | R$ 380.00 | R$ 380.00 |
| 07 | Speech Therapist Progress Report – Written clinical report detailing progress, updated treatment plan, and recommendations for home exercises (prepared in São Paulo, Brazil) | June 10, 2025 | — | R$ 200.00 | R$ 200.00 |
| 08 | Speech Therapist Family Consultation – Guidance session for caregivers on speech development strategies and home-based intervention techniques | June 12, 2025 | 40 min | R$ 250.00 | R$ 250.00 |
| Subtotal | R$ 3,220.00 |
| Insurance Coverage (80%) | - R$ 2,576.00 |
| Co-payment (20%) | R$ 644.00 |
| ICMS / Tax (0% – Exempt Medical Service) | R$ 0.00 |
| Total Due (BRL) | R$ 644.00 |
This invoice pertains to professional Speech Therapist services rendered by Dr. Mariana Costa Ferreira, a licensed Speech Therapist (Fonoaudiólogo) registered with the Conselho Federal de Fonoaudiologia (CREFONO) in the state of São Paulo, Brazil. All sessions were conducted at the Clínica Fonoaudiária São Paulo facility located in the Bela Vista district of São Paulo, Brazil. The Speech Therapist treatment plan was developed following the initial comprehensive assessment and is aligned with the clinical guidelines established by the Brazilian Ministry of Health for speech and language intervention. The patient, Mr. Ricardo Almeida Santos, is a resident of the Jardins neighborhood in São Paulo, Brazil, and has been receiving ongoing Speech Therapist care for articulation difficulties and phonological disorder. This invoice covers the period from May 5, 2025, through June 12, 2025. Payment of this invoice is due within 30 days of the issue date. Please reference Invoice No. SP-2025-04872 on all correspondence and insurance claims related to these Speech Therapist services in Brazil São Paulo. Terms and Conditions:
1. This invoice is issued in accordance with Brazilian tax regulations (Lei 8.662/93 and related CREFONO bylaws) governing the billing of Speech Therapist professional services in the state of São Paulo, Brazil.
2. The Speech Therapist services described herein are covered under the patient's Unimed São Paulo health insurance policy. The co-payment amount of R$ 644.00 is the patient's financial responsibility as per the 20% co-payment clause in the insurance contract.
3. Payment may be made via bank transfer (PIX or TED) to the account details provided on the payment slip, or by credit card (up to 3 installments without interest).
4. Late payments on this invoice will incur a 2% administrative fee plus interest of 1% per month, in compliance with Brazilian civil code provisions.
5. The Speech Therapist retains the right to suspend ongoing therapy sessions in São Paulo, Brazil, if payment is not received within 15 days past the due date.
6. This invoice constitutes a valid tax document (Nota Fiscal) for the services rendered. A digital copy is available upon request via the clinic's patient portal.
7. All Speech Therapist clinical records associated with this invoice are stored in compliance with Brazil's General Data Protection Law (LGPD – Lei 13.709/2018). ⬇️ Download as DOCX Edit online as DOCX
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