Medical receipt template
A patient receipt for clinics, therapists and private practitioners: services with procedure codes, insurance adjustments, what the patient paid and any balance.
Free· no account· no watermark· PNG up to 4×
Click anything in the picture to edit it
Size and mixed formatting
Size and mixed formatting
Size and mixed formatting
Layout
Amount, size and style
Amount, size and style
Amount, size and style
Amount, size and style
Amount, size and style
Amount, size and style
Subtotal is $245.00 from the line items.
Layout
Size and mixed formatting
How it works
How to use the medical receipt template
- 01Add your practice name, address and phone.
- 02Fill in the patient, date of service, provider and receipt number.
- 03List services with codes and fees; enter insurance amounts.
- 04Print or email it to the patient.
What a medical receipt should show
The practice and provider, the patient, the date of service, each service with its code and fee, insurance adjustments and payments, the patient's share, what was paid and the balance.
For practitioners
Therapists, chiropractors, physiotherapists, dentists and small clinics without a billing system can issue a clear receipt after each visit.
FAQ
Questions
Is this medical receipt template free?
Yes. Edit it, download a PNG at print quality or print it, with no sign-up and no watermark.
Do the totals add up by themselves?
Yes. Quantities multiply out, then subtotal, tax, tips, fees, discounts, total, change and balance due are worked out for you. Any row can also take a fixed amount.
Can I use it for returns or expense claims?
No. A receipt for a real purchase comes from the business that took the payment. Use this template to write receipts for payments you received, and for props, design, training and fun. Making one up to claim money is fraud.
Templates are for record-keeping, props, design, testing and teaching. Using a made-up receipt to claim expenses, refunds, warranty or tax deductions is fraud. Mockling is not affiliated with any business.