Quotation Estimate Doctor General Practitioner in Belgium Brussels –Free Word Template Download with AI

Dear Valued Patient,

Thank you for considering the services of our Doctor General Practitioner practice located in the heart of Brussels, Belgium. This Quotation Estimate outlines the comprehensive range of primary care services available at our cabinet on Avenue Louise. As a registered Doctor General Practitioner with the RIZIV/INAMI (National Institute for Health and Disability Insurance), we are committed to providing accessible, high-quality medical care to all residents of the Brussels-Capital Region and surrounding municipalities. Please review the following itemised costs for the services you have requested. All prices are expressed in Euros (EUR) and reflect the standard fee schedule applicable in Belgium Brussels for the 2025 calendar year.

As a Doctor General Practitioner registered with the RIZIV/INAMI in Belgium Brussels, the majority of the services listed above are covered under the Belgian national health insurance system. The standard reimbursement rate for a first consultation with a Doctor General Practitioner is 70% of the regulated fee, with the remaining 30% co-payment borne by the patient. For patients enrolled in a mutualité (mutuelle) with a supplementary contract, the co-payment may be further reduced or fully covered. The estimated patient out-of-pocket cost after RIZIV/INAMI reimbursement for the services in this Quotation Estimate is approximately € 160.50, subject to your specific mutualité coverage terms. Please verify your exact reimbursement percentage with your mutualité (e.g., Solidaris, CM, CMH, LCM, etc.) prior to the consultation.

• This Quotation Estimate is valid for a period of 30 calendar days from the date of issue. After this period, fees may be subject to revision in accordance with the Belgian federal fee schedule updates.
• All prices are quoted in Euros (EUR) and include applicable Belgian VAT where legally required. Medical consultations with a Doctor General Practitioner are generally exempt from VAT under Belgian tax law (Article 44 of the VAT Code).
• Payment is due at the time of service unless a different arrangement has been agreed in writing. Accepted payment methods include bank transfer (IBAN BE), credit/debit card, and cash. Invoicing will be issued in accordance with Belgian fiscal regulations.
• This Quotation Estimate does not constitute a binding contract for medical treatment. The Doctor General Practitioner reserves the right to modify the treatment plan based on clinical findings during the consultation.
• Home visits within the Brussels-Capital Region are subject to availability and may incur additional travel surcharges for locations outside the 1050, 1040, 1000, 1080, and 1070 postal codes.
• Emergency or after-hours consultations (outside Mon–Fri 08:00–18:00) are not included in this Quotation Estimate and will be billed separately at the applicable Belgian emergency rate.
• All medical records and documentation are maintained in compliance with the Belgian Law of 22 December 1993 on the rights of the patient and the GDPR (EU 2016/679). Patient data is stored securely at the cabinet in Brussels and is never shared without explicit written consent.
• This Quotation Estimate is prepared exclusively for the named patient and is non-transferable. Any changes to the scope of services must be approved in writing by the Doctor General Practitioner prior to execution.
• In the event of a dispute regarding fees or services, the parties agree to first seek an amicable resolution. Should this fail, the competent courts of Brussels (Bruxelles-Brussel) shall have exclusive jurisdiction in accordance with Belgian law.

By signing below, the patient acknowledges receipt of this Quotation Estimate for Doctor General Practitioner services in Belgium Brussels and agrees to the terms and conditions outlined above. This signature does not obligate the patient to proceed with all listed services but confirms understanding of the estimated costs and reimbursement framework.