Quotation Estimate Dietitian in United States Chicago –Free Word Template Download with AI
Professional Dietitian Services — United States Chicago
Prepared By
Dr. Margaret Ellison, RD, LD
Lakefront Nutrition & Dietetics Group
1420 N. Lake Shore Drive, Suite 850
Chicago, Illinois 60610
United States
Phone: (312) 555-0147
Email: [email protected]
Prepared For
Mr. James R. Whitfield
Whitfield Family Wellness Program
2847 W. Diversey Parkway
Chicago, Illinois 60622
United States
Phone: (773) 555-0892
Email: [email protected]
This Quotation Estimate is formally issued by Lakefront Nutrition & Dietetics Group to provide Mr. James R. Whitfield with a comprehensive, itemized financial projection for the engagement of a licensed Dietitian to deliver personalized nutritional counseling, meal planning, and ongoing dietary management services. All services described herein will be rendered within the metropolitan area of United States Chicago, specifically at our Lake Shore Drive office or via telehealth consultation as mutually agreed upon. This document serves as a binding cost estimate for the full twelve-month program period and is intended to facilitate the client's internal budgeting and approval processes.
The licensed Dietitian assigned to this engagement will hold a Registered Dietitian (RD) credential and a Licensed Dietitian (LD) designation as recognized by the Illinois Department of Public Health and the Academy of Nutrition and Dietetics. The scope of services includes comprehensive nutritional assessment, evidence-based dietary intervention planning, chronic disease nutrition management, and quarterly progress evaluations tailored to the client's specific health objectives within the United States Chicago healthcare ecosystem.
| Item No. | Service Description | Frequency | Unit Cost (USD) | Total (USD) |
|---|---|---|---|---|
| 01 | Initial Comprehensive Nutritional Assessment & Medical History Review (Dietitian-led, 90-minute session) | One-time | $275.00 | $275.00 |
| 02 | Personalized Meal Plan Development & Dietary Prescription (Chicago-area grocery sourcing guide included) | One-time | $185.00 | $185.00 |
| 03 | Bi-Weekly Follow-Up Consultation with the Dietitian (45-minute in-person or telehealth session) | 24 sessions | $145.00 | $3,480.00 |
| 04 | Quarterly Nutritional Progress Evaluation & Plan Adjustment (60-minute session with lab review) | 4 sessions | $210.00 | $840.00 |
| 05 | Specialized Chronic Disease Nutrition Management (Diabetes & Hypertension protocol, United States Chicago regional dietary guidelines) | 12 months | $95.00/mo | $1,140.00 |
| 06 | 24/7 Secure Messaging Access to the Dietitian for dietary questions and emergency meal substitutions | 12 months | $35.00/mo | $420.00 |
| 07 | Annual Comprehensive Nutrition Report & Year-End Dietary Summary (delivered to client and primary care physician) | One-time | $150.00 | $150.00 |
| 08 | Chicago Community Nutrition Workshop Participation (2 group sessions per year at local United States Chicago venues) | 2 sessions | $75.00 | $150.00 |
| Subtotal | $6,640.00 |
| Illinois State Sales Tax (10.25%) | $680.60 |
| Administrative & Scheduling Fee | $120.00 |
| Grand Total (USD) | $7,440.60 |
This Quotation Estimate assumes payment in United States Dollars (USD) via ACH bank transfer, certified check, or major credit card. The total program fee of $7,440.60 may be paid in full upon contract execution or in twelve equal monthly installments of $620.05. A 15% non-refundable deposit of $1,116.09 is required to secure the Dietitian's schedule and confirm the program start date. Late payments exceeding fifteen (15) calendar days will incur a 1.5% monthly interest charge as permitted under Illinois commercial code regulations applicable in United States Chicago.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After the expiration date, all pricing is subject to revision based on current market rates for Dietitian services in the United States Chicago metropolitan area.
- All services will be performed by a board-certified, state-licensed Dietitian in compliance with the Illinois Public Health Code and the standards of practice established by the Academy of Nutrition and Dietetics.
- The client acknowledges that this Quotation Estimate does not constitute a medical diagnosis or a guarantee of specific health outcomes. The Dietitian will operate within the scope of registered dietetic practice as defined by Illinois state law.
- Rescheduling of any Dietitian consultation requires a minimum of 48 hours' written notice. Cancellations made within 48 hours will be subject to a 50% session fee.
- All client health records, dietary data, and consultation notes will be maintained in strict accordance with the Health Insurance Portability and Accountability Act (HIPAA) and Illinois personal information protection statutes.
- This Quotation Estimate is governed by the laws of the State of Illinois, United States, and any disputes arising from the engagement of Dietitian services shall be resolved through binding arbitration in Cook County, United States Chicago.
- Any modifications to the scope of services, program duration, or service frequency must be documented in a written amendment signed by both parties and will be reflected in a revised Quotation Estimate.
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of all terms, conditions, and the scope of Dietitian services to be provided in United States Chicago, and authorizes Lakefront Nutrition & Dietetics Group to commence the engagement upon receipt of the required deposit.
Prepared By: Dr. Margaret Ellison, RD, LDLakefront Nutrition & Dietetics Group
Date: ______________________ Accepted By (Client): Mr. James R. Whitfield
Whitfield Family Wellness Program
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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