Quotation Estimate Dietitian in United States Miami –Free Word Template Download with AI

Quotation Reference

Quotation Estimate No.: QTE-MIA-2025-00472

Date of Issue: June 12, 2025

Valid Until: July 12, 2025 (30 days)

Prepared By: Maria Delgado, RD, LD – Lead Dietitian

Client Information

Client Name: [Client Full Name]

Address: [Client Address], Miami, FL 33101

Phone: [Client Phone Number]

Email: [Client Email Address]

Insurance Provider: [Insurance Company Name]

This Quotation Estimate is issued by Coastal Wellness Nutrition & Dietetics, LLC, a licensed and accredited nutrition practice operating in the United States Miami metropolitan area. The following Dietitian services have been tailored to meet the specific health and nutritional needs of the client as discussed during the initial consultation on June 5, 2025, at our Miami office located in the Brickell district.

Our Dietitian team, led by a Registered Dietitian Nutritionist (RDN) with over fifteen years of clinical experience in the United States Miami community, provides comprehensive, evidence-based nutritional counseling. All services outlined in this Quotation Estimate comply with the Florida Department of Health regulations governing the practice of dietetics and nutrition within the state of Florida, United States.

Item No.	Description of Dietitian Service	Frequency	Duration	Unit Price (USD)	Subtotal (USD)
01	Initial Comprehensive Nutritional Assessment by a Licensed Dietitian – includes full dietary history, anthropometric measurements, metabolic panel review, and personalized nutrition risk evaluation specific to the United States Miami climate and lifestyle factors.	One-time	90 minutes	$275.00	$275.00
02	Personalized Meal Planning and Dietary Prescription – a customized weekly meal plan developed by the Dietitian incorporating local Miami produce, seafood, and culturally appropriate foods available in the United States Miami area.	One-time	60 minutes	$185.00	$185.00
03	Follow-up Nutritional Counseling Sessions with the Dietitian – ongoing monitoring of progress, dietary adherence review, and plan adjustments. Conducted at our Miami office or via secure telehealth platform.	Bi-weekly (8 sessions)	45 minutes each	$145.00	$1,160.00
04	Specialized Metabolic Syndrome Management Program – a structured twelve-week intervention by the Dietitian targeting blood glucose regulation, lipid management, and weight optimization, designed for clients residing in the United States Miami region.	12 weeks	30 minutes/week	$120.00	$1,440.00
05	Nutritional Education Workshop (Group of up to 6) – a one-hour educational session led by the Dietitian covering topics such as Mediterranean diet adaptation, tropical fruit nutrition, and sodium management for residents of the United States Miami area.	One-time	60 minutes	$350.00	$350.00
06	Emergency Dietitian Consultation and Telephone Support – access to the Dietitian for urgent dietary questions, medication-nutrient interaction concerns, or acute dietary emergencies. Available Monday through Saturday, 8:00 AM to 6:00 PM EST.	As needed (up to 10 calls)	15 minutes each	$65.00	$650.00
07	Annual Comprehensive Re-evaluation by the Dietitian – a full reassessment of nutritional status, updated laboratory interpretation, and revised dietary plan for the following year in the United States Miami practice.	One-time (Year 1)	75 minutes	$225.00	$225.00

Subtotal for All Dietitian Services	$4,285.00
Applicable Florida Sales Tax (7.0% on non-medical items)	$24.50
Insurance Pre-Authorization Coordination Fee	$0.00 (Waived)
TOTAL QUOTATION ESTIMATE AMOUNT	$4,309.50

All prices are quoted in United States Dollars (USD). This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing for the Dietitian services may be subject to revision based on current market conditions in the United States Miami healthcare sector.

This Quotation Estimate constitutes a formal offer for the Dietitian services described herein and is binding only upon written acceptance by the client within the validity period stated above.
All Dietitian services will be performed by a Registered Dietitian Nutritionist (RDN) licensed by the State of Florida and in good standing with the Academy of Nutrition and Dietetics. The practice operates exclusively in the United States Miami metropolitan area and its surrounding counties (Miami-Dade, Monroe, and Broward).
Payment for the services outlined in this Quotation Estimate is due within fifteen (15) business days of the invoice date. Accepted payment methods include credit card (Visa, Mastercard, American Express), bank transfer (ACH), and certified check. A 1.5% monthly late fee will apply to overdue balances.
Insurance billing: Our Dietitian practice accepts most major insurance carriers operating in the United States Miami region, including Aetna, Cigna, UnitedHealthcare, and Florida Blue. The client is responsible for any co-pays, deductibles, or non-covered portions as determined by their specific insurance plan. Pre-authorization will be obtained by our office prior to the commencement of services.
Cancellation Policy: Appointments for Dietitian sessions must be rescheduled or cancelled at least twenty-four (24) hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee as indicated in this Quotation Estimate.
Confidentiality: All client health information, dietary records, and consultation notes are protected under the Health Insurance Portability and Accountability Act (HIPAA) and Florida state privacy statutes. No information will be disclosed without written client consent.
This Quotation Estimate does not constitute a guarantee of specific health outcomes. The Dietitian services are advisory and educational in nature and do not replace medical treatment prescribed by a physician. Clients are encouraged to maintain concurrent care with their primary care provider in the United States Miami area.
Any modifications to the scope of Dietitian services after acceptance of this Quotation Estimate will require a written amendment signed by both parties. Additional services not listed herein will be quoted separately.
Governing Law: This Quotation Estimate and any resulting agreement shall be governed by and construed in accordance with the laws of the State of Florida, United States of America. Any disputes shall be resolved through mediation in Miami-Dade County, Florida.

By signing below, the client acknowledges receipt of this Quotation Estimate for Dietitian services in the United States Miami area and agrees to the terms, conditions, and pricing outlined in this document. The client confirms that they have had the opportunity to review all details and ask questions regarding the proposed Dietitian care plan.

Client Signature

Name: ____________________________

Date: ____________________________

Dietitian / Authorized Representative

Name: Maria Delgado, RD, LD

Date: ____________________________

⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT