Invoice template

Medical invoice template

A worked example medical invoice: services, an insurance adjustment, and the patient balance, with Net 30 terms. Download or send live.

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This is a free medical invoice template: a worked example invoice you can download as a PDF, Excel, or Word file, or open as a live invoice and send in about 30 seconds. The example below is filled in with realistic line items, amounts, and payment terms for medical work. The sender block is left blank ("Your business name") because that is the part you fill in with your own details.

Your business name

Your street address
Your city, Your country

SAMPLE-001

Issued Aug 13, 2026
Due Sep 12, 2026

Bill To

Jordan Lee

72 Maple Court Columbus, OH 43004 United States

PO Number

ACCT-20481

Currency

USD

Description Qty Price Total
Office consultation, established patient 1 $180.00 $180.00
Diagnostic lab panel 1 $120.00 $120.00
Follow-up visit 1 $90.00 $90.00
Insurance adjustment and payment 1 -$210.00 -$210.00
Subtotal $180.00
Total Due $180.00

Net 30. This statement reflects the patient responsibility after insurance. Please include the account number with your payment.

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Free, no signup. The download is a clean template you fill in with your own details.

What this template includes

The fields every medical invoice realistically needs, laid out the way an accounts payable team expects to read it:

  • •Your business details: name, address, and tax ID. Blank in the template, ready for you to fill in.
  • •Client and billing entity, with a clear Bill To block.
  • •Invoice number, issue date, and due date, plus a PO number field for clients whose AP process needs one.
  • •Line items with quantity and rate. The Excel version totals them for you with built-in formulas.
  • •Payment terms, including space for late-fee wording so the due date is enforceable.

Three ways to use this template

Download the PDF

A print-ready, send-ready invoice. Best when you want a fixed document to fill in and email.

Download the Excel file

A fully editable spreadsheet. The Amount and total cells use formulas, so the math stays correct as you edit.

Use it as a live invoice

Open it in JupiterInvoice pre-filled with this example. Send it as a link your client can open, add a PO number to, and approve.

Medical invoice template FAQ

What should a medical invoice include?
A medical invoice (or patient statement) should show the practice details, the patient and account number, the dates of service, and each service as a line item. Note the amount insurance covered and the patient responsibility that remains, then the balance due and how to pay. Keep it clear enough that a patient can reconcile it against their explanation of benefits.
How do medical practices invoice patients after insurance?
The practice bills insurance first, then invoices the patient for the remaining responsibility: copays, coinsurance, deductible, and any non-covered services. Show the total charge, the insurance adjustment and payment, and the patient balance, so the amount due is transparent.
Is this medical invoice template free?
Yes. Download the PDF or Excel version with no signup and no payment. You can also open it as a live invoice on JupiterInvoice, which is free to send.
What is the difference between the PDF, Excel, and Word versions?
The PDF is a fixed, print-ready and send-ready document. The Excel version is fully editable and its Amount and total cells use formulas, so the math recalculates as you change quantities and rates. The Word version is an editable document you type over, with static totals, and it opens in Word, Google Docs, or Pages. Pick whichever fits how you work.
Do I need an account to use the template?
No. The PDF, Excel, and Word downloads need no account. If you use the live version, you can build and send a first invoice without signing up; an account just saves your business details so the next invoice pre-fills.
Whose details are in the template?
The sender block is left as placeholders ("Your business name") because that is the part you personalize. The line items, amounts, and terms are a realistic example for medical work, meant to be replaced with your own.
Can I edit the line items and amounts?
Yes. The example content is a starting point. In the Excel file you edit the cells directly; in the live version you change every field on the invoice. Replace the sample line items with your own work.
How is the live version better than a downloaded file?
A downloaded file is static: you fill it in and email it. The live JupiterInvoice version is a link your client opens in the browser, where they can add their PO number, correct billing details, and approve it for payment, with the totals calculated for you.

Last updated August 5, 2026

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