Invoice Speech Therapist in Israel Jerusalem –Free Word Template Download with AI
Dr. Miriam Levi, M.S. CCC-SLP
Speech Therapist & Clinical Linguist
Jerusalem Speech & Language Center
14 King David Street, Jerusalem, Israel 97100
Tel: +972-2-625-4830
Email: [email protected]
VAT No: 51-204-887-3
Billed To (Client)
Mr. David Cohen
Cohen Family Residence
22 Herzl Street, Rehavia
Jerusalem, Israel 94500
Tel: +972-52-774-1192
Email: [email protected]
Invoice Details
Invoice Date: June 15, 2025
Service Period: May 1 – May 31, 2025
Due Date: July 15, 2025
Currency: Israeli New Shekel (ILS / ₪)
Referral: Dr. Yosef Peretz, Pediatrician
Services Rendered – Speech Therapist Sessions in Israel Jerusalem| Ref | Service Description | Date(s) | Duration | Rate (₪) | Amount (₪) |
|---|---|---|---|---|---|
| 01 | Initial Speech Therapist Assessment – Comprehensive evaluation of articulation, phonology, and oral-motor function for child patient (age 5) | May 2, 2025 | 90 min | 650.00 | 650.00 |
| 02 | Individual Speech Therapy Session – Articulation and phonological remediation targeting /r/, /l/, and /s/ sounds | May 5, 2025 | 45 min | 380.00 | 380.00 |
| 03 | Individual Speech Therapy Session – Language development and expressive vocabulary expansion exercises | May 12, 2025 | 45 min | 380.00 | 380.00 |
| 04 | Individual Speech Therapy Session – Fluency and speech rhythm training with parent coaching component | May 19, 2025 | 45 min | 380.00 | 380.00 |
| 05 | Individual Speech Therapy Session – Social communication and pragmatic language skills in group setting (4 children) | May 23, 2025 | 60 min | 220.00 | 220.00 |
| 06 | Parent Consultation – Home practice guidance, progress review, and updated therapy plan by the Speech Therapist | May 28, 2025 | 30 min | 250.00 | 250.00 |
| 07 | Written Progress Report – Detailed clinical summary submitted to referring pediatrician and school speech program in Jerusalem | May 30, 2025 | — | 180.00 | 180.00 |
| Subtotal | 2,440.00 |
|---|---|
| VAT (18%) | 439.20 |
| Insurance Reimbursement (Bituach Leumi / Maccabi) | -1,220.00 |
| Grand Total Due | 1,659.20 |
Important Notes Regarding This Invoice
- This Invoice is issued by a licensed Speech Therapist operating under the regulations of the Israeli Ministry of Health and the Jerusalem Municipal Health Authority. All services were delivered at the Jerusalem Speech & Language Center, located in the heart of Israel Jerusalem.
- The Speech Therapist, Dr. Miriam Levi, holds a valid license from the Israeli Association of Speech-Language Pathologists (IA-SLP) and is registered with the Israeli Medical Council. Her license number is SLP-IL-2019-0342.
- Payment for this Invoice is due within thirty (30) days of the invoice date. Late payments may incur a monthly interest charge of 1.5% in accordance with Israeli commercial law (Section 18 of the Interest Law, 5713-1953).
- Insurance reimbursement has been pre-processed with the client's health fund (Maccabi Health Services, Jerusalem branch). The client is responsible for the remaining balance as indicated on this Invoice. Please retain this document for your personal records and any further insurance claims.
- All Speech Therapist sessions conducted during the service period were documented in the client's confidential medical file in compliance with Israeli privacy law (Privacy Protection Law, 5741-1981) and the regulations governing healthcare records in Israel Jerusalem.
- Should the client wish to dispute any line item on this Invoice, a written notice must be submitted to the Speech Therapist's office within fourteen (14) days of receipt. The Speech Therapist will review the claim and respond within ten (10) business days.
- For clients residing in the Jerusalem metropolitan area, a complimentary follow-up consultation is available within six months of the final therapy session. This benefit is not transferable and applies only to the primary patient named on this Invoice.
Please remit payment for this Invoice using one of the following methods accepted by the Speech Therapist's office in Israel Jerusalem:
Bank Transfer: Bank of Jerusalem, Branch 001, Account No. 000-445-882-1, IBAN: IL14 0001 0000 0000 4458 821
Credit/Debit Card: Visa, Mastercard, or Bankcard accepted at the clinic office (14 King David Street, Jerusalem)
Online Payment: Via the secure portal at www.jerusalemspeech.co.il/payments (reference Invoice No: ST-JR-2025-04872)
Cash or Check: Payable to "Jerusalem Speech & Language Center" at the front desk, Monday through Thursday, 09:00–17:00
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