What should a speech therapy invoice include?

Your practice details, an invoice number and date, payment terms and a due date, and who you're billing: the client, and a responsible party if someone else pays. Then each service with its date, a plain description, any code you use, the quantity and fee, the total, any payments made at sessions, and the amount due with how to pay.

What goes in the Code column?

In this template every line shows a "[Code]" placeholder. If you use service codes, enter your own. Which codes a payer accepts, if any, is up to that payer, so check with the payer. If you don't use codes, leave the column blank.

Can a client submit this invoice to their insurance?

This is a self-pay invoice, not an insurance claim, and it makes no statement about coverage. If a client wants an insurer, a school district or another program to pay or reimburse them, they should check with that payer about what it needs.

How do I show payments made at each session?

Enter the total on the "Less: payment at session" line, and list when each payment was received in the billing notes. The amount due is the total less those payments. If nothing was paid at sessions, set the line to 0.00 in the Excel file rather than deleting it.

Should I put session notes or results on the invoice?

No. List services, dates and fees only. Session notes, assessment results and other clinical details belong in the client's record, not on an invoice that may be emailed or forwarded.

Free Speech Therapist Invoice Template

A free self-pay invoice for speech therapy that lists an evaluation and therapy sessions by date with their fees, keeps service codes as placeholders, takes off payments made at sessions and shows the amount due, as a blank PDF form plus Word and Excel files filled with sample values

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Quick answer:This page has a free self-pay invoice for a speech therapy practice billing a client, or the person responsible for paying, such as a parent. It lists each service by date (an evaluation and therapy sessions) with a [Code] placeholder, quantity, fee and amount, takes off payments made at sessions and shows the amount due with payment terms and how to pay. It has a placeholder for a license number where one is required, keeps session notes and clinical details off the invoice, and is not an insurance claim. It comes as a blank print-and-fill PDF and as Word and Excel files filled with sample values.

SPEECH THERAPY INVOICE

Practice

Business name:: Example Speech Therapy
Address:: 18 Example Court, Suite 2, Sampletown
Phone / email:: [Phone or email]
Therapist:: [Therapist name]
License no.:: [License no., if required where you work]

Invoice details

Invoice no.:: ST-0412
Invoice date:: Nov 30, 2026
Payment terms:: Net 14
Due date:: Dec 14, 2026
Account no.:: [Client account no.]

Bill to (client or responsible party)

Client name:: [Client name]
Responsible party:: [Name, if different]
Address:: [Address]
Email:: [Email]

Sessions

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

Services

Service: Speech and language evaluationAmount: 200.00
Date:
Nov 3
Code:
[Code]
Qty:
1
Fee:
200.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 10
Code:
[Code]
Qty:
1
Fee:
110.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 17
Code:
[Code]
Qty:
1
Fee:
110.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 24
Code:
[Code]
Qty:
1
Fee:
110.00

Services: line items
Date	Service	Code	Qty	Fee	Amount
Nov 3	Speech and language evaluation	[Code]	1	200.00	200.00
Nov 10	Therapy session, 45 min	[Code]	1	110.00	110.00
Nov 17	Therapy session, 45 min	[Code]	1	110.00	110.00
Nov 24	Therapy session, 45 min	[Code]	1	110.00	110.00

Subtotal: 530.00
Total: 530.00
Less: payment at session: 330.00
Amount due: 200.00

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 ST-0412

Billing notes

Self-pay fees for the services listed. Payment at session: 110.00 received on each of Nov 10, Nov 17 and Nov 24, 2026.
Service codes are shown as [Code] placeholders; enter your own codes if you use them.
This invoice lists services and fees only; session notes stay in the client's record with the practice.

Please quote the invoice number with your payment.

Speech therapy self-pay invoice: sample preview. Download it below.

Key Features

Everything you need in a professional invoice template.

Practice details with the therapist's name and a license number placeholder

Invoice number, invoice date, payment terms, due date and client account number

Bill to: client and a separate responsible party field

Session dates and payment type (self-pay)

Services table: date, service, [Code] placeholder, qty, fee and amount

Subtotal, total, "Less: payment at session" and amount due

How to pay: accepted methods, account and bank detail placeholders, payment reference

Billing notes on payments received; no fields for session notes or clinical details

Blank PDF to print and fill in; Word and Excel versions with sample values to overwrite

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 payment at session.

SPEECH THERAPY INVOICE

Practice

Business name:: Example Speech Therapy
Address:: 18 Example Court, Suite 2, Sampletown
Phone / email:: [Phone or email]
Therapist:: [Therapist name]
License no.:: [License no., if required where you work]

Invoice details

Invoice no.:: ST-0412
Invoice date:: Nov 30, 2026
Payment terms:: Net 14
Due date:: Dec 14, 2026
Account no.:: [Client account no.]

Bill to (client or responsible party)

Client name:: [Client name]
Responsible party:: [Name, if different]
Address:: [Address]
Email:: [Email]

Sessions

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

Services

Service: Speech and language evaluationAmount: 200.00
Date:
Nov 3
Code:
[Code]
Qty:
1
Fee:
200.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 10
Code:
[Code]
Qty:
1
Fee:
110.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 17
Code:
[Code]
Qty:
1
Fee:
110.00
Service: Therapy session, 45 minAmount: 110.00
Date:
Nov 24
Code:
[Code]
Qty:
1
Fee:
110.00

Services: line items
Date	Service	Code	Qty	Fee	Amount
Nov 3	Speech and language evaluation	[Code]	1	200.00	200.00
Nov 10	Therapy session, 45 min	[Code]	1	110.00	110.00
Nov 17	Therapy session, 45 min	[Code]	1	110.00	110.00
Nov 24	Therapy session, 45 min	[Code]	1	110.00	110.00

Subtotal: 530.00
Total: 530.00
Less: payment at session: 330.00
Amount due: 200.00

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 ST-0412

Billing notes

Self-pay fees for the services listed. Payment at session: 110.00 received on each of Nov 10, Nov 17 and Nov 24, 2026.
Service codes are shown as [Code] placeholders; enter your own codes if you use them.
This invoice lists services and fees only; session notes stay in the client's record with the practice.

Please quote the invoice number with your payment.

Speech therapy self-pay invoice

A self-pay invoice for speech therapy: the client as a placeholder, session dates, an evaluation fee and session fees with bracketed code placeholders, the payments made at each session and the amount due.

A request for payment — shows the amount due

Download

What this speech therapy invoice is for

This template is for a speech therapy practice billing a self-pay client for evaluations and sessions. You send it to the client, or to the person responsible for paying, such as a parent. The sample bills one evaluation and three 45-minute sessions in November, where the client paid for each session on the day, so only the evaluation is still owed.

It is an invoice, not an insurance claim. If a client wants to ask an insurer, a school district or another program to pay or reimburse them, that payer decides what it needs, so check with the payer.

The speech therapy invoice has:

Practice: business name, address, phone or email, the therapist's name, and License no., with the placeholder "[License no., if required where you work]".
Invoice details: invoice number, invoice date, payment terms, due date and the client Account no.
Bill to (client or responsible party): client name, a Responsible party field for whoever pays if that's someone else, address and email.
Sessions: the session dates and the payment type ("Self-pay").
Services: a table with Date, Service, Code, Qty, Fee and Amount.
Totals: Subtotal, Total, "Less: payment at session" and Amount due.
How to pay: accepted methods, placeholders for the account name and bank details, and the payment reference to quote.
Billing notes: the payments received at sessions, a note that service codes are placeholders, and a note that the invoice lists services and fees only.

It comes as three files:

PDF: a blank form to print and fill in by hand.
Word (.docx) and Excel (.xlsx): the same layout filled with sample values for you to overwrite.

In the Excel file, each line's Amount is Qty × Fee rounded to the cent, and the services table has two empty rows. The Subtotal adds the lines, and the Total equals the Subtotal. The Amount due is the Total less the "Less: payment at session" amount you type in. The file's tip says: to leave out "Less: payment at session", set it to 0.00, and don't delete the rows, because the totals refer to them. In the Word file you can delete lines you don't need.

The sample adds up like this: a $200.00 evaluation on Nov 3, then three sessions at $110.00 on Nov 10, 17 and 24. The total is $530.00. The client paid $110.00 at each of the three sessions, so $330.00 comes off, and the amount due is $200.00 for the evaluation. The invoice is dated Nov 30, 2026, on Net 14 terms, so it's due Dec 14, 2026. These are sample fees only, not typical fees.

Listing services and codes

One line per service, with its date, so the client can match the invoice to their appointments.
Describe each service in plain words with its length, as the sample does ("Speech and language evaluation", "Therapy session, 45 min").
Codes are placeholders. The Code column shows "[Code]" on every line. If you use service codes, enter your own. Which codes a payer accepts, if any, is up to that payer, so check with the payer. Leave the placeholders blank or delete the column in Word if you don't use codes.
Qty × Fee = Amount. Use the quantity for repeated services billed at the same fee on the same date.

Payments at sessions and the amount due

"Less: payment at session" takes off what the client has already paid at appointments. The sample's billing notes say when each payment was received ("110.00 received on each of Nov 10, Nov 17 and Nov 24, 2026"), so the client can check them.
Only deduct payments you've received. If nothing was paid at sessions, set the line to 0.00.
Print an actual due date as well as the terms, and the payment reference you want quoted. When the client pays, you can confirm it with a payment receipt.

Privacy and what stays off the invoice

The invoice describes services, dates and fees. Keep session notes, assessment results and clinical details out of it: invoices get emailed, forwarded and filed, and they don't need that information to be paid. The sample's billing note puts it this way: "This invoice lists services and fees only; session notes stay in the client's record with the practice."

Use the Account no. to match payments to the client instead of repeating personal details. For a child, bill the parent or guardian as the responsible party.

License number

The License no. field is a placeholder. Whether you need to show a license number on invoices depends on where you practice, so check with your state licensing board. Leave the field blank if it isn't required.

Invoice templates by format: PDF, Excel, Word, Google Docs and Google Sheets, or browse all invoice templates.

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What's included in this invoice template

	This invoice	Payment receipt	Payer's claim
Purpose	Bills a self-pay client	Confirms an invoice was paid	Asks a payer to pay under its rules
Sent to	Client or responsible party	Whoever paid	The payer
Shows	Services by date, fees, payments at sessions, amount due	Amount paid, method, balance 0.00	Whatever the payer requires

When this isn't for you

If a payer needs its own claim form or billing process, use that rather than this self-pay invoice. If your practice management software already issues invoices, use it so your records and the invoice match.