Invoice Speech Therapist in Venezuela Caracas –Free Word Template Download with AI
Speech Therapy & Communication Center
Av. Francisco de Miranda, Torre Empresarial, Piso 12, Ofic. 1204
Chacao, Venezuela Caracas, 1060
RIF: J-45872319-K
Phone: +58 212-555-7843 | Email: [email protected]
Billed To (Client)
Mr. Alejandro Rivas Mendoza
Residential Address: Urbanización El Rosal, Calle Principal, Casa 17
Chacao, Venezuela Caracas, 1061
Phone: +58 414-223-8891
Email: [email protected]
C.I.: V-14.287.563
Service Provider
Dr. María Fernanda Gutiérrez López
Licensed Speech Therapist
Professional License: C.S. 08-44721
Specialization: Pediatric & Adult Speech-Language Pathology
Registered with: Colegio de Fonoaudiólogos de Venezuela
Practice Location: Venezuela Caracas, Chacao
Description of Speech Therapy Services Rendered
| # | Service Description | Date(s) | Sessions | Rate (VES) | Amount (VES) | Duration |
|---|---|---|---|---|---|---|
| 1 | Initial Speech Therapy Assessment & Diagnostic Evaluation for child patient (age 5) – articulation disorder screening, oral-motor examination, and standardized language testing | May 5, 2025 | 1 | 2,850.00 | 2,850.00 | 90 min |
| 2 | Weekly Speech Therapy Sessions – Articulation & Phonological Intervention (individual sessions conducted by the Speech Therapist at the Venezuela Caracas clinic) | May 8 – Jun 13 | 8 | 1,450.00 | 11,600.00 | 45 min each |
| 3 | Parental Guidance & Home Practice Training – Speech Therapist instruction to caregivers on reinforcing articulation exercises and language development strategies at home | May 22, 2025 | 1 | 1,200.00 | 1,200.00 | 60 min |
| 4 | Progress Evaluation & Mid-Treatment Report – Comprehensive assessment of speech improvement, updated treatment plan, and written clinical report for the family | Jun 6, 2025 | 1 | 1,800.00 | 1,800.00 | 60 min |
| 5 | Supplementary Auditory-Verbal Therapy Session – specialized intervention targeting auditory processing and verbal response skills, administered by the Speech Therapist | Jun 10, 2025 | 1 | 1,650.00 | 1,650.00 | 45 min |
| 6 | Therapeutic Materials & Resources – Purchase of articulation cards, oral-motor tools, and personalized speech exercise booklets provided by the Speech Therapist for home use | May 8, 2025 | 1 | 950.00 | 950.00 | N/A |
| Subtotal | 19,050.00 VES |
| IVA (16% – Venezuelan Value Added Tax) | 3,048.00 VES |
| Professional Service Surcharge (5%) | 952.50 VES |
| Discount – Early Payment (5%) | -952.50 VES |
| TOTAL AMOUNT DUE | 22,098.00 VES |
Payment Instructions
Method 1 – Bank Transfer: Banco Mercantil, Account No. 0105-0000-45-1234567890, Beneficiary: Clínica Habla Libre C.A., RIF J-45872319-K. Please reference Invoice No. HL-2025-04871 in the transfer memo.
Method 2 – Cash Payment: Acceptable at the clinic office located in Venezuela Caracas, Chacao, Monday through Friday, 8:00 AM to 5:00 PM. A receipt will be issued upon payment.
Method 3 – Mobile Payment: Pago Móvil – Banco de Venezuela, C.I. V-20.458.723, Phone: 0414-555-7843. Reference: Invoice HL-2025-04871.
Due Date: This Invoice must be settled no later than June 30, 2025. A late payment penalty of 2% per month will be applied to outstanding balances after the due date, in accordance with Venezuelan commercial regulations.
Important Notes & Terms
1. This Invoice covers all Speech Therapy services rendered by Dr. María Fernanda Gutiérrez López, licensed Speech Therapist, at the Clínica Habla Libre facility in Venezuela Caracas during the period of May 5, 2025 through June 13, 2025.
2. All sessions were conducted in person at the clinic located in Chacao, Venezuela Caracas. No telehealth or remote sessions are included in this billing period.
3. The Speech Therapist reserves the right to adjust the treatment plan based on the patient's progress. Any additional sessions beyond those listed in this Invoice will be billed separately with a new Invoice document.
4. Cancellation policy: Sessions cancelled less than 24 hours in advance will be charged at 50% of the session rate. This policy was communicated to the client at the time of the initial consultation.
5. This Invoice is valid for 30 calendar days from the date of issue. After this period, the Speech Therapist's office reserves the right to reissue the document with applicable adjustments.
6. For any questions regarding this Invoice or the Speech Therapy services provided, please contact the billing department at [email protected] or call +58 212-555-7843 during business hours.
7. All services are subject to the professional standards established by the Colegio de Fonoaudiólogos de Venezuela and applicable health regulations in the Bolivarian Republic of Venezuela.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT