Invoice Veterinarian in United States Houston –Free Word Template Download with AI
Licensed Veterinarian Practice | Houston, Texas, United States
4820 Westheimer Road, Suite 210, Houston, TX 77056, United States
Phone: (713) 555-0142 | Email: [email protected]
Texas Veterinary License No. TX-VET-2024-08831 | EIN: 74-2839105
INVOICEInvoice Details
Invoice Number: INV-2025-04-00872
Invoice Date: June 14, 2025
Due Date: July 14, 2025
Service Date: June 10, 2025
Status: PENDING
Billed To (Client)
Mr. Jonathan R. Whitfield
1247 Maple Grove Lane
Houston, TX 77024, United States
Phone: (281) 555-0397
Email: [email protected]
Patient Information
Pet Name: Biscuit
Species / Breed: Canine / Golden Retriever
Age: 6 years
Weight: 72 lbs (32.7 kg)
Microchip ID: 985-112-003-447-821
Attending Veterinarian
Dr. Sarah M. Chen, DVM, DACVIM
Board-Certified Internal Medicine
Bayou City Veterinary Clinic
Houston, Texas, United States
License: TX-VET-2019-04412
Services Rendered – Veterinarian Invoice Line Items
| # | Description of Service | CPT / Code | Qty | Unit Price | Amount |
|---|---|---|---|---|---|
| 1 | Comprehensive Veterinary Examination – Full physical assessment by Veterinarian Dr. Chen including auscultation, palpation, and neurological evaluation | VET-EXAM-001 | 1 | $125.00 | $125.00 |
| 2 | Digital Radiography (4 views) – Thoracic and abdominal imaging performed at our Houston, United States facility | VET-RAD-004 | 1 | $285.00 | $285.00 |
| 3 | Complete Blood Count (CBC) and Serum Biochemistry Panel – Laboratory work processed in-house | VET-LAB-012 | 1 | $195.00 | $195.00 |
| 4 | Urinalysis with Sediment Examination – Performed by certified veterinary technician | VET-LAB-019 | 1 | $65.00 | $65.00 |
| 5 | Subcutaneous Fluid Therapy (1,500 mL Lactated Ringer's Solution) – Administered over 4 hours | VET-TX-033 | 1 | $140.00 | $140.00 |
| 6 | Prescription Medication – Carprofen 75 mg tablets (30-count) for post-procedure anti-inflammatory management | VET-RX-045 | 1 | $89.00 | $89.00 |
| 7 | Prescription Medication – Omeprazole 20 mg capsules (30-count) for gastrointestinal protection | VET-RX-052 | 1 | $62.00 | $62.00 |
| 8 | Follow-up Telephone Consultation with Veterinarian – 15-minute post-treatment check-in call | VET-CONS-007 | 1 | $45.00 | $45.00 |
| 9 | Diagnostic Ultrasound – Abdominal soft tissue evaluation by Veterinarian Dr. Chen | VET-ULTRA-008 | 1 | $220.00 | $220.00 |
| Subtotal | $1,226.00 |
| Pet Insurance Adjustment (Trupanion Policy #TP-88291) | -$485.00 |
| Adjustable Subtotal | $741.00 |
| Texas Sales Tax (8.25% – Harris County, Houston, United States) | $61.13 |
| TOTAL DUE | $802.13 |
Accepted Payment Methods for This Invoice
Credit Card (Visa, Mastercard, American Express) | Check | ACH Bank Transfer | Cash | Pet Insurance Direct Billing
Payment Due Within: 30 days from Invoice date. Late payments are subject to a 1.5% monthly finance charge as permitted under Texas Business & Commerce Code.
Terms, Conditions & Notes Regarding This Veterinarian Invoice
- This Invoice is issued by Bayou City Veterinary Clinic, a licensed Veterinarian practice operating in Houston, Texas, United States. All services were rendered in compliance with the Texas Veterinary Medical Practice Act (Texas Occupations Code, Chapter 165).
- The attending Veterinarian, Dr. Sarah M. Chen, DVM, assumes full professional responsibility for the clinical judgment and treatment plan documented in this Invoice. All diagnostic and therapeutic procedures were performed at our facility located in Houston, United States.
- Payment for this Invoice is due within thirty (30) calendar days of the Invoice date. If payment is not received by the due date, a late fee of 1.5% per month will be applied to the outstanding balance. This policy is consistent with standard billing practices for Veterinarian services in the Houston, Texas metropolitan area.
- Insurance claims have been submitted on behalf of the client to Trupanion Pet Insurance. The adjustment amount reflected in this Invoice represents the approved reimbursement. The client is responsible for any co-pay, deductible, or non-covered charges as outlined in their specific policy. Please contact your insurance provider directly for questions regarding coverage.
- Prescription medications listed in this Invoice are dispensed under the supervision of the attending Veterinarian and are subject to Texas Pharmacy Board regulations. Refills, if applicable, must be requested through our clinic in Houston, United States, and are subject to a separate dispensing fee.
- This Invoice does not constitute a guarantee of outcome. Veterinary medicine, like all medical disciplines, involves inherent risks and uncertainties. The client acknowledges that the Veterinarian has exercised reasonable professional judgment in the care of the patient.
- For questions regarding this Invoice, please contact our billing department at (713) 555-0142 or [email protected]. Our office is located at 4820 Westheimer Road, Suite 210, Houston, TX 77056, United States, and is open Monday through Friday, 8:00 AM to 6:00 PM Central Time.
- Bayou City Veterinary Clinic is a HIPAA-compliant and Texas Medical Records Act-compliant facility. All patient records associated with this Invoice are maintained in accordance with applicable federal and state privacy regulations.
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