Therapractics Invoice
THERAPRACTICS, LLC INVOICE (Cash, Check or Credit Card) Invoice #:_______ Date:_______ 
Dr. Guy Morrison, R.P.T., D.C.
AVAILABLE OPTIONS
| Description | Price | Amount |
|
Initial Consult/Eval |
$100 | $______ |
| Chiro/PT adjustments (includes 5 min. massage to assist in the adjustment) |
$50 | $______ |
| Massage (5 min. to assist the adjustment) |
$5 | $______ |
| Home Exercise Program (Exercise instruction and handout serves as a curative and/or injury preventative measure addressing specific postural deviations) |
$50 | $______ |
|
Theraband |
$5 | $______ |
|
Group/Business Presentation |
$350 | $______ |
| Miscellaneous Services | $___ | $______ |
| $___ | $______ | |
| Total |
$______ |
(A minimum of 3 patients will be necessary for on-site treatments by appointment only considering the travel and set up time. A treatment room or space is required and must be authorized by management.)
Pt. Name:_______________
Pt. Phone #:_____________
Paid by cash____ Amt paid $______
Paid by check____ Amt paid $______ Ck #:_______
Paid by credit card: visa__ mc__ discover__ am. exp.__ paypal__
other_______________ Amt paid $_______
(Since I am currently contracting at Tustin Irvine Medical Group (TIMG), I will not treat any patients that have any connection with TIMG except at that Clinic under their guidelines.)
Fax (714) 957-1347
Phone (714) 397-0467
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