Invoice Speech Therapist in India Mumbai –Free Word Template Download with AI
Registered Speech Therapist Practice
402, Wellness Tower, Linking Road, Bandra West
Mumbai, Maharashtra – 400050, India
GSTIN: 27AABCU1234F1Z5
Phone: +91-98765-43210 | Email: [email protected]
Invoice No: CV/2025/00487
Date: 15 June 2025
Due Date: 30 June 2025
Billed To (Client Details)
Mr. Rajesh Kumar Sharma
12, Green Meadows Society, Andheri East
Mumbai, Maharashtra – 400069, India
PAN: ABCDE1234F
Phone: +91-91234-56789
Service Details
Therapist: Dr. Ananya Deshmukh, M.S. (Speech-Language Pathology)
Registration No: SLP/IN/MUM/2019/0042
Diagnosis: Childhood Apraxia of Speech (CAS)
Referring Physician: Dr. S. Patil, Pediatric Neurologist
Session Period: 01 May 2025 – 31 May 2025
| Sr. No. | Description of Speech Therapy Service | Qty / Sessions | Rate (INR) | Amount (INR) |
|---|---|---|---|---|
| 1 | Individual Speech Therapy Session – Articulation and Phonological Intervention (45 min per session) | 12 | 1,500.00 | 18,000.00 |
| 2 | Oral Motor Therapy and Feeding Assessment (30 min per session) | 6 | 1,200.00 | 7,200.00 |
| 3 | Language Comprehension and Expression Therapy – Group Session (60 min) | 4 | 800.00 | 3,200.00 |
| 4 | Initial Comprehensive Speech and Language Assessment (90 min) | 1 | 3,500.00 | 3,500.00 |
| 5 | Parent Training and Home Practice Guidance Workshop (60 min) | 2 | 1,000.00 | 2,000.00 |
| 6 | Progress Report and Therapeutic Plan Revision (Monthly) | 1 | 1,500.00 | 1,500.00 |
| 7 | Home Therapy Kit – Articulation Cards, Visual Aids, and Practice Materials | 1 | 2,800.00 | 2,800.00 |
| Subtotal (INR) | 38,200.00 |
| GST @ 18% (INR) | 6,876.00 |
| Convenience Fee (INR) | 150.00 |
| Grand Total (INR) | 45,226.00 |
Payment Instructions
Mode of Payment: Bank Transfer / UPI / NEFT / RTGS
Bank Name: State Bank of India, Bandra West Branch, Mumbai
Account Name: ClearVoice Speech & Language Clinic
Account Number: 30124567890123
IFSC Code: SBIN0001234
UPI ID: clearvoicemumbai@okaxis
Reference: Please quote Invoice No. CV/2025/00487 in the remarks field.
Important Notes and Terms
1. This Invoice is issued by a registered Speech Therapist operating in India Mumbai under the guidelines of the Rehabilitation Council of India (RCI). All speech therapy services rendered are conducted in compliance with Indian healthcare regulations and professional ethical standards.
2. The payment due date for this Invoice is 30 June 2025. A late payment surcharge of 2% per month will be applicable on any outstanding balance beyond the due date as per the terms agreed upon at the time of engagement.
3. All speech therapy sessions listed in this Invoice were conducted at the clinic premises located in Bandra West, Mumbai, or via approved tele-therapy platforms as per the therapeutic plan. The Speech Therapist reserves the right to reschedule sessions with a minimum of 24 hours prior notice.
4. GST has been applied at the standard rate of 18% as applicable to healthcare and allied services in India. The GSTIN mentioned above is valid for the purpose of tax compliance and filing in the state of Maharashtra, India Mumbai jurisdiction.
5. This Invoice does not constitute a medical prescription. The Speech Therapist's recommendations and therapeutic interventions are advisory in nature and should be followed in conjunction with the guidance of the referring pediatric neurologist or pediatrician.
6. In the event of any dispute regarding the services billed in this Invoice, the matter shall be resolved through arbitration in Mumbai, Maharashtra, India, in accordance with the Arbitration and Conciliation Act, 1996.
7. The client acknowledges that the Speech Therapist in India Mumbai has provided all necessary disclosures regarding the scope of treatment, expected outcomes, and potential limitations of speech and language therapy for the diagnosed condition.
Authorized Signatory – ClearVoice Speech & Language Clinic
Dr. Ananya Deshmukh, Lead Speech Therapist
Client Acknowledgment
Mr. Rajesh Kumar Sharma
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT