Invoice Speech Therapist in Philippines Manila –Free Word Template Download with AI
245 Makati Avenue, Unit 8B, Makati City
Philippines Manila, Metro Manila 1200
Tel: +63 (2) 8887-4521 | Email: [email protected]
PRC License No. 2019-04521 | DOH Accredited
Licensed Speech Therapist PracticeBill To (Client)
Name: Mr. and Mrs. Alejandro Reyes
Address: 18 Brgy. San Isidro, Quezon City
Philippines Manila, Metro Manila 1101
Contact: +63 917 555-8832
Email: [email protected]
Client ID: CVST-CLT-2024-0312
Provider (Speech Therapist)
Lead Therapist: Ms. Maria Clara Santos, M.Ed., CCC-SLP
Specialization: Pediatric Speech-Language Pathology
Practice Location: Philippines Manila
Referring Physician: Dr. Juan P. Villanueva, MD
Insurance Ref: Maxicare Policy #MC-9928471
| # | Date of Service | Description of Speech Therapy Service | Duration | Rate (PHP) | Amount (PHP) |
|---|---|---|---|---|---|
| 1 | May 20, 2025 | Individual Speech Therapy Session – Articulation and Phonological Intervention for 6-year-old patient (Alexis Reyes). Focus on /r/ and /l/ sound production with oral-motor exercises. | 60 min | 2,500.00 | 2,500.00 |
| 2 | May 27, 2025 | Individual Speech Therapy Session – Language Comprehension and Expression Therapy. Structured activities targeting vocabulary expansion and sentence formulation. | 60 min | 2,500.00 | 2,500.00 |
| 3 | June 3, 2025 | Individual Speech Therapy Session – Fluency and Stuttering Intervention. Applied shaping and modeling techniques with parent coaching component. | 60 min | 2,500.00 | 2,500.00 |
| 4 | June 10, 2025 | Comprehensive Speech-Language Reassessment. Administration of standardized assessment tools (CELF-5, PPVT-IV) and clinical report preparation for the referring physician in Philippines Manila. | 90 min | 4,000.00 | 4,000.00 |
| 5 | June 12, 2025 | Parent Training and Home Program Consultation. Guidance on implementing speech therapy exercises at home, review of progress, and adjustment of therapy goals. | 45 min | 1,800.00 | 1,800.00 |
| 6 | June 14, 2025 | Individual Speech Therapy Session – Social Pragmatics and Communication Skills. Role-play scenarios targeting turn-taking, topic maintenance, and appropriate conversational behavior. | 60 min | 2,500.00 | 2,500.00 |
| Subtotal | PHP 15,300.00 |
| Insurance Adjustment (Maxicare 70%) | - PHP 10,710.00 |
| Client Co-Payment (30%) | PHP 4,590.00 |
| 12% VAT (on co-payment) | PHP 550.80 |
| TOTAL DUE | PHP 5,140.80 |
Payment Instructions
Bank Transfer: BDO Unibank, Inc. – Account Name: ClearVoice Speech Therapy Center, Inc. – Account No. 001234567890 – Branch: Makati City, Philippines Manila
Over-the-Counter: GCash / Maya – Mobile No. 0917-555-8832 (ClearVoice Speech Therapy)
Cash / Check: Payable to "ClearVoice Speech Therapy Center, Inc." at our office in Makati City, Philippines Manila (Mon–Fri, 8:00 AM – 5:00 PM)
Reference: Please include Invoice No. CVST-2025-00847 as the payment reference.
Important Notes and Terms
1. This Invoice covers all Speech Therapy services rendered by our licensed Speech Therapist team at our Philippines Manila facility during the billing period of May 20, 2025 to June 14, 2025.
2. All speech therapy sessions were conducted in compliance with the Philippine Department of Health (DOH) guidelines and the Professional Regulation Commission (PRC) standards for speech-language pathology practice.
3. Insurance claims have been submitted to Maxicare on behalf of the client. The amounts reflected in this Invoice represent the client's co-payment responsibility after insurance processing.
4. Payment is due within fifteen (15) calendar days from the date of this Invoice. A late payment surcharge of 1.5% per month will be applied to outstanding balances.
5. This Invoice does not constitute a medical diagnosis. All therapy recommendations are based on clinical assessment by a qualified Speech Therapist and are subject to the treating physician's approval.
6. For questions regarding this Invoice or your child's speech therapy progress, please contact our billing department at +63 (2) 8887-4521 or email [email protected]. Our office is located in Makati City, Philippines Manila, and is accessible via the EDSA–Makati Avenue intersection.
7. This document is valid as an official Invoice for tax and reimbursement purposes in the Republic of the Philippines. An Official Receipt (OR) will be issued upon confirmation of payment.
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