What should an acupuncture invoice include?

Your practice name, address, contact details and practitioner; an invoice number, invoice date, payment terms, due date and the client's account number; the client; the visit dates; each visit with its date, service, fee and amount; any package credit; the amount due; and how to pay.

How do I show a prepaid package on the invoice?

List the visits the package covers at the package rate, enter what the client paid for the package on the Less: package credit line, and note when it was bought and which visits it applies to. In the sample, 3 follow-up visits at 80.00 are covered exactly by the 240.00 package, so only the 120.00 initial visit is due.

What goes in the Code column?

The sample shows [Code] placeholders. Enter your own service codes if you use them, or leave the column empty.

How does the Excel file calculate the amount due?

Each Amount is Qty × Fee. The Subtotal adds the visits, the Total equals the Subtotal because there's no tax line, and the Amount due is the Total minus the package credit you type. The template tip asks you to set the credit to 0.00 rather than delete rows.

Can I type into the PDF?

The PDF is a blank form to print and fill in by hand. To type your details, use the Word or Excel file, then save or print it as a PDF if your client wants one.

Free Acupuncturist Self-Pay Invoice Template

Q: Can a client use this invoice for an insurance claim?

It's set up as a self-pay invoice, with Payment type reading Self-pay. If a client wants to claim the visits from an insurance plan or another payer, they should check with that payer what it needs.

A free self-pay invoice for an acupuncture practice, with each visit listed by date and fee, placeholders for service codes, a prepaid package credit and the amount due, as a blank PDF form plus Word and Excel files

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Quick answer:This page has a free acupuncture self-pay invoice for a practice billing a client who pays directly. It shows the practice name, address, contact details, practitioner and a license number placeholder; an invoice number, invoice date, payment terms, due date and client account number; the client as placeholders; visit dates and payment type; a Visits table with Date, Service, Code, Qty, Fee and Amount; and a Subtotal, Total, "Less: package credit" and Amount due, with no tax line. Service codes are [Code] placeholders. The PDF is a blank A4 form to print and fill in; the Word and Excel files carry sample details, and the Excel file calculates the amounts and totals.

ACUPUNCTURE INVOICE

Practice

Practice name:: Example Acupuncture Studio
Address:: 88 Example Garden Road, Sampletown
Phone / email:: [Phone or email]
Practitioner:: [Practitioner name]
License no.:: [License no., if required where you work]

Invoice details

Invoice no.:: AC-0519
Invoice date:: Nov 30, 2026
Payment terms:: Net 14
Due date:: Dec 14, 2026
Account no.:: [Client account no.]

Bill to (client)

Client name:: [Client name]
Address:: [Address]
Email:: [Email]

Visit summary

Visit dates:: Nov 3, Nov 10, Nov 17 and Nov 24, 2026
Payment type:: Self-pay

Visits

Service: Initial visit and consultationAmount: 120.00
Date:
Nov 3
Code:
[Code]
Qty:
1
Fee:
120.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 10
Code:
[Code]
Qty:
1
Fee:
80.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 17
Code:
[Code]
Qty:
1
Fee:
80.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 24
Code:
[Code]
Qty:
1
Fee:
80.00

Visits: line items
Date	Service	Code	Qty	Fee	Amount
Nov 3	Initial visit and consultation	[Code]	1	120.00	120.00
Nov 10	Follow-up visit	[Code]	1	80.00	80.00
Nov 17	Follow-up visit	[Code]	1	80.00	80.00
Nov 24	Follow-up visit	[Code]	1	80.00	80.00

Subtotal: 360.00
Total: 360.00
Less: package credit: 240.00
Amount due: 120.00

How to pay

Accepted methods:: Card, bank transfer or check
Account name:: [Account name]
Bank details:: [Bank name, account and routing numbers]
Payment reference:: Invoice AC-0519

Billing notes

Package credit: a package of 3 follow-up visits bought on Oct 30, 2026, for 240.00, applied to the visits on Nov 10, Nov 17 and Nov 24.
Service codes are shown as [Code] placeholders; enter your own codes if you use them.
This invoice lists services and fees only; visit notes stay in the client's record at the practice.

Please quote the invoice number with your payment.

Acupuncture self-pay invoice: sample preview. Download it below.

Key Features

Everything you need in a professional invoice template.

Practice details with practitioner and a license number placeholder

Invoice no., invoice date, payment terms, due date and client account no.

Bill to (client) with client name, address and email as placeholders

Visit summary: visit dates and payment type (self-pay)

Visits table with date, service, code placeholder, qty, fee and amount

Subtotal, Total, "Less: package credit" and Amount due, with no tax line

Billing notes for the package credit, code placeholders and what stays off the invoice

Blank PDF form plus Word (.docx) and Excel (.xlsx) versions with sample details and live totals in Excel

Download the invoice template

The PDF is a blank invoice to print and fill in by hand. The Word and Excel files contain the sample details shown in the preview, ready for you to replace with your own. In the Excel file, each line amount is a formula: "Qty" × "Fee". The subtotal, total and amount due are formulas too. The amount due is the total minus the package credit.

ACUPUNCTURE INVOICE

Practice

Practice name:: Example Acupuncture Studio
Address:: 88 Example Garden Road, Sampletown
Phone / email:: [Phone or email]
Practitioner:: [Practitioner name]
License no.:: [License no., if required where you work]

Invoice details

Invoice no.:: AC-0519
Invoice date:: Nov 30, 2026
Payment terms:: Net 14
Due date:: Dec 14, 2026
Account no.:: [Client account no.]

Bill to (client)

Client name:: [Client name]
Address:: [Address]
Email:: [Email]

Visit summary

Visit dates:: Nov 3, Nov 10, Nov 17 and Nov 24, 2026
Payment type:: Self-pay

Visits

Service: Initial visit and consultationAmount: 120.00
Date:
Nov 3
Code:
[Code]
Qty:
1
Fee:
120.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 10
Code:
[Code]
Qty:
1
Fee:
80.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 17
Code:
[Code]
Qty:
1
Fee:
80.00
Service: Follow-up visitAmount: 80.00
Date:
Nov 24
Code:
[Code]
Qty:
1
Fee:
80.00

Visits: line items
Date	Service	Code	Qty	Fee	Amount
Nov 3	Initial visit and consultation	[Code]	1	120.00	120.00
Nov 10	Follow-up visit	[Code]	1	80.00	80.00
Nov 17	Follow-up visit	[Code]	1	80.00	80.00
Nov 24	Follow-up visit	[Code]	1	80.00	80.00

Subtotal: 360.00
Total: 360.00
Less: package credit: 240.00
Amount due: 120.00

How to pay

Accepted methods:: Card, bank transfer or check
Account name:: [Account name]
Bank details:: [Bank name, account and routing numbers]
Payment reference:: Invoice AC-0519

Billing notes

Package credit: a package of 3 follow-up visits bought on Oct 30, 2026, for 240.00, applied to the visits on Nov 10, Nov 17 and Nov 24.
Service codes are shown as [Code] placeholders; enter your own codes if you use them.
This invoice lists services and fees only; visit notes stay in the client's record at the practice.

Please quote the invoice number with your payment.

Acupuncture self-pay invoice

A self-pay invoice from an acupuncture practice: the client as a placeholder, an initial visit and follow-up visits by date with bracketed code placeholders, a prepaid package credited against the follow-up visits and the amount due.

A request for payment — shows the amount due

Download

What's on the acupuncture invoice

The acupuncture self-pay invoice bills a client who pays the practice directly for a month of visits. It has:

Practice: Practice name, Address, Phone / email, Practitioner and License no. The sample reads "[License no., if required where you work]".
Invoice details: Invoice no., Invoice date, Payment terms, Due date and Account no.
Bill to (client): Client name, Address and Email, all left as placeholders in the sample.
Visit summary: Visit dates and Payment type ("Self-pay").
Visits: one line per visit, with Date, Service, Code, Qty, Fee and Amount, plus two empty lines.
Totals: Subtotal, Total, Less: package credit and Amount due.
How to pay: accepted methods, placeholders for your account name and bank details, and the payment reference to quote.
Billing notes: what the package credit covers, how the code placeholders work, and what the invoice leaves out.

It comes as three files:

PDF: a one-page blank form to print and fill in by hand. It's sized for A4 paper, so if you print on US Letter, check the scaling setting in your print dialog.
Word (.docx) and Excel (.xlsx): the same layout filled with sample details. Overwrite them with your own.

In the Excel file:

Each Amount is Qty × Fee.
The Subtotal, the Total and the Amount due are formulas. The Total equals the Subtotal, because there's no tax line.
You type the package credit yourself. To leave it out, set it to 0.00 rather than deleting rows, because the totals refer to them.

The sample works out like this:

an initial visit and consultation on Nov 3 at 120.00, and follow-up visits on Nov 10, Nov 17 and Nov 24 at the package rate of 80.00 each;
a Subtotal and Total of 360.00;
less a 240.00 package credit, leaving 120.00 due by Dec 14, 2026 on Net 14 terms.

The sample fees only show how the form works. They aren't typical fees, so use your own.

Visits and service codes

Give each visit its own line with the date and the service, such as "Initial visit and consultation" or "Follow-up visit", and list the dates in Visit dates so the client can match the invoice to their appointments.

The Code column holds "[Code]" placeholders. If you use service codes, enter your own; if you don't, leave the column empty. The invoice lists services and fees only, and the sample's note says visit notes "stay in the client's record at the practice", so keep clinical details off the invoice.

Package credits

The sample client bought a package of 3 follow-up visits on Oct 30, 2026, for 240.00, and the billing note applies it to the visits on Nov 10, Nov 17 and Nov 24. Those visits are listed at the package rate, 80.00 each, or 240.00 together, so Less: package credit takes them off exactly. The amount due is 360.00 − 240.00 = 120.00, which is the initial visit only.

If your package price is lower than your regular fee, list the visits it covers at the package rate, as the sample does, so the credit matches them and the client isn't charged for them twice. Note when the package was bought and which visits it covers, as the sample does.

Self-pay, payers and licensing

This invoice is set up for clients who pay you directly: Payment type reads "Self-pay". If a client wants to claim the visits from an insurance plan or another payer, they should check with that payer what it needs.

The License no. field is a placeholder. Whether you need a license, and whether the number must appear on invoices, depends on where you practice, so check the rules where you work.

Getting paid

Set the Payment terms and Due date to what you agreed with the client. Net 14 is only the sample. How to pay lists the accepted methods and the Payment reference to quote, here the invoice number.

To let clients pay online instead, send the invoice from Billed, which publishes this page. Billed connects to Stripe and PayPal, and only their standard rates apply (accept payments). When a client pays, you can give them a payment receipt.

Related templates

Other wellness practices: the massage therapist invoice, the chiropractor invoice, the dietitian invoice and the yoga teacher invoice.
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All invoice templates.

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What's included in this invoice template

Part	What it holds
Practice	Practice name, address, phone or email, practitioner, license no.
Invoice details	Invoice no., invoice date, payment terms, due date, account no.
Bill to (client)	Client name, address, email
Visit summary	Visit dates, payment type
Visits	Date, service, code, qty, fee, amount
Totals	Subtotal, total, less: package credit, amount due
How to pay	Accepted methods, account and bank placeholders, payment reference
Billing notes	Package credit, code placeholders, what stays off the invoice

When this isn't for you

This invoice is for clients who pay the practice directly. If you bill an insurance plan or another payer, use the form or format that payer asks for.