Purchase Order Psychiatrist in Thailand Bangkok –Free Word Template Download with AI
Siam Wellness Corporate Health Group Co., Ltd.
128 Sukhumvit Road, Khlong Toei, Bangkok 10110, Thailand
Tax ID: 0105556789012 | Tel: +66-2-255-4321 | Email: [email protected]
VENDOR / SERVICE PROVIDER INFORMATION| Field | Details |
|---|---|
| Provider Name | Dr. Ananya Chaiyaporn, M.D. (Psychiatrist) |
| Practice Name | Bangkok Mind & Body Psychiatry Clinic |
| Address | 45/12 Ratchadamri Road, Lumphini, Pathum Wan, Bangkok 10330, Thailand |
| Licence No. | Thai Medical Council Licence: 12345-67890 |
| Contact Person | Ms. Siriporn Wattanapong (Practice Manager) |
| Phone / Email | +66-2-251-8899 / [email protected] |
| Item # | Description of Service | Quantity | Unit | Unit Price (THB) | Amount (THB) | |
|---|---|---|---|---|---|---|
| 1 | Initial psychiatric consultation and comprehensive mental health assessment for corporate employees (60-minute session) – Psychiatrist Dr. Ananya Chaiyaporn, Bangkok Mind & Body Psychiatry Clinic, Thailand Bangkok | 25 | Sessions | 3,500.00 | 87,500.00 | |
| 2 | Follow-up psychiatric therapy sessions (45-minute session) – Psychiatrist-led cognitive behavioural therapy and medication management, delivered at the clinic in Thailand Bangkok | 100 | Sessions | 2,800.00 | 280,000.00 | |
| 3 | Psychiatric group wellness workshop for corporate staff (3-hour session) – Conducted by the Psychiatrist at Siam Wellness office, Sukhumvit, Thailand Bangkok | 4 | Workshops | 15,000.00 | 60,000.00 | |
| 4 | Urgent psychiatric telehealth consultation (30-minute video session) – Psychiatrist available 24/7 for employee crisis support, Thailand Bangkok coverage | 20 | Sessions | 2,000.00 | 40,000.00 | |
| 5 | Psychiatric medication review and prescription management (30-minute session) – Psychiatrist-led pharmacological assessment, Thailand Bangkok | 50 | Sessions | 2,200.00 | 110,000.00 | |
| 6 | Confidential psychiatric case management and progress reporting (monthly) – Psychiatrist submits anonymised aggregate reports to Siam Wellness HR department | 6 | Months | 8,000.00 | 48,000.00 | |
| SUBTOTAL | 625,500.00 | |||||
| VAT (7%) | 43,785.00 | |||||
| TOTAL AMOUNT DUE (THB) | 669,285.00 | |||||
1. This Purchase Order is issued by Siam Wellness Corporate Health Group Co., Ltd. (hereinafter referred to as the "Buyer") to Bangkok Mind & Body Psychiatry Clinic, represented by Dr. Ananya Chaiyaporn, M.D., Psychiatrist (hereinafter referred to as the "Vendor"), for the provision of psychiatric and mental health services in Thailand Bangkok.
2. All services described in this Purchase Order shall be performed by a licensed Psychiatrist registered with the Thai Medical Council. The Vendor guarantees that the Psychiatrist assigned to this contract holds valid professional credentials and maintains malpractice insurance coverage in Thailand.
3. The service delivery location for all in-person sessions shall be the Vendor's clinic at 45/12 Ratchadamri Road, Lumphini, Pathum Wan, Bangkok 10330, Thailand, unless otherwise specified in the line items above. Group workshops shall be conducted at the Buyer's premises in Sukhumvit, Thailand Bangkok.
4. The Vendor shall maintain strict confidentiality in accordance with the Personal Data Protection Act B.E. 2562 (2019) of Thailand. All psychiatric records, patient notes, and case management reports shall be stored securely and shall not be disclosed to any third party without written consent from the patient, except as required by Thai law.
5. Payment shall be made within thirty (30) calendar days from the date of invoice receipt. Payment shall be made via bank transfer to the Vendor's designated account in Thai Baht (THB). The Vendor shall issue a proper tax invoice (Fap Kaw) in accordance with the Revenue Department of Thailand regulations.
6. The Vendor shall provide a minimum of forty-eight (48) hours' written notice for any cancellation or rescheduling of a Psychiatrist session. Cancellations made within forty-eight hours shall be subject to a 50% fee of the session price. The Buyer reserves the right to cancel this Purchase Order in its entirety with thirty (30) days' written notice, subject to payment for services already rendered.
7. In the event of a dispute arising from this Purchase Order, both parties agree to first attempt resolution through good-faith negotiation. If unresolved, the matter shall be submitted to the courts of competent jurisdiction in Bangkok, Thailand, and governed by the laws of the Kingdom of Thailand.
8. This Purchase Order shall remain valid until 14 July 2025. Any services not scheduled or delivered by the expiry date shall require a written amendment to this Purchase Order signed by both parties.
9. The Vendor acknowledges that this Purchase Order constitutes a binding agreement upon signature by both parties. No verbal modifications shall be valid unless confirmed in writing and appended to this document.
AUTHORISATION AND SIGNATURESFor and on behalf of the Buyer:
Siam Wellness Corporate Health Group Co., Ltd.
Mr. Thanasak RattanakornChief Procurement Officer
Date: _______________
For and on behalf of the Vendor:
Bangkok Mind & Body Psychiatry Clinic
Dr. Ananya Chaiyaporn, M.D.Psychiatrist / Medical Director
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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