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Therapy Receipt

A therapy receipt shows proof of payment for mental health or counseling services. It is commonly used for insurance reimbursement, HSA/FSA claims, and employer wellness programs. Therapy receipts usually include session length, provider credentials, and total paid.

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THERAPY RECEIPT
Outpatient Clinic: Riverside Health Clinic Phone: (415) 555-0139 Patient: Olivia Nguyen Provider: Dr. S. Patel Service: Specialist Consultation
02/14/2026, 21:06:49
Provider: ClearMind Therapy Center Licensed Clinical Psychologist
Patient: Emily Carter Session Date: 04/02/2032 Session Length: 50 minutes
Individual Therapy Session
$165.00
Total Paid
$165.00
Card number
**** **** **** 1234
Card type
Debit
Card entry
Chip
Date/time
06/04/2022 9:35 AM
Reference #
11111111111111A
Status
APPROVED