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Medical invoice template

An invoice for private practices and clinics that bill patients directly: the date of service and account number, each visit, test or procedure with its fee, and any payment taken at the visit.

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Medical invoice template: an example, filled in

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What’s in this template

  • Date of service and account number fields
  • A line for each visit, test or procedure
  • Amount paid at the visit, and balance due
  • A tax line you can leave at zero
  • Notes for billing questions and how to pay

How to fill it in

  1. Pick a format. Download the Word or Excel file or the printable PDF, or fill the template in online and download the finished PDF. The Word and Excel files also open in Google Docs and Google Sheets.
  2. Add the patient. Fill in your practice, the patient's name and address, the date of service and the patient's account number.
  3. List the services. Put the visit, each test and each procedure on its own line with your fee, in plain words the patient will recognize.
  4. Subtract what was paid and send. Enter any payment taken at check-in under Amount paid, add a phone number for billing questions and send the invoice.

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When to use it

For doctors, therapists, clinics and other private practices that bill patients for self-pay visits and services. If a patient came in more than once, add the date to each line so they can match the bill to their visits.

Tips

  • Use plain names. “Office visit” and “flu vaccine” are easier for a patient to check than internal codes.
  • Take payment at the visit where you can, and show it under Amount paid so the balance is clear.
  • Say who to call. A phone number or email for billing questions in the notes settles most questions before the due date. Our medical billing guide answers more.

Frequently asked questions

Can I send this invoice to an insurance company?

No. Insurers use their own claim forms, such as the CMS-1500 for professional services in the US, or the electronic version of it. This template is for billing patients directly, for example for self-pay visits.

How much medical detail should the invoice show?

Only what the patient needs to recognize the charges, such as "office visit" or "rapid strep test". Some patients ask for an itemized statement, often called a superbill, so they can claim reimbursement themselves. Follow the privacy rules that apply to your practice.

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