Quotation Estimate Doctor General Practitioner in Canada Montreal –Free Word Template Download with AI
Doctor General Practitioner Services — Canada Montreal
Montreal General Practice Clinic Inc. | 1450 Rue Sainte-Catherine Ouest, Suite 3200, Montreal, Quebec, Canada H3G 1X4
| Quotation Estimate No.: | QTE-MTL-2025-04872 | Date of Issue: | June 12, 2025 |
| Valid Until: | July 12, 2025 (30 days) | Currency: | Canadian Dollars (CAD $) |
| Prepared For: | Client / Insured Party Name | Client Reference: | REF-2025-8841 |
| Service Provider: | Dr. [Name], MD, FRCPC — Doctor General Practitioner | License No.: | Quebec College of Physicians (CMPQ) #45218 |
| Practice Location: | Canada Montreal — Montreal, Quebec, Canada (Serving the Greater Montreal Metropolitan Area) | ||
This Quotation Estimate document has been prepared by Montreal General Practice Clinic Inc. to provide a comprehensive and transparent breakdown of anticipated medical fees for the services rendered by our Doctor General Practitioner to the client identified above. This estimate is issued in accordance with the fee schedules established by the Quebec College of Physicians and Surgeons (CMPQ) and the Quebec Health Insurance Act (R.S.Q., c. A-25.001). All pricing reflects the current 2025 fee schedule applicable to private and supplementary insurance billing within the province of Quebec, Canada.
Please note that this Quotation Estimate is a good-faith projection of costs based on the scope of services discussed during the initial consultation. Actual charges may vary depending on the clinical findings, additional diagnostic procedures required, or changes in the treatment plan as determined by the attending Doctor General Practitioner in the course of care delivery in Canada Montreal.
The following services are encompassed within this Quotation Estimate and are to be delivered by a licensed Doctor General Practitioner at our practice facility located in the heart of Canada Montreal:
| # | Service Description | Fee Code (CMPQ) | Qty / Freq. | Unit Price (CAD) | Subtotal (CAD) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Medical Consultation — Doctor General Practitioner (includes history, physical examination, and preliminary assessment) | 11-10-00 | 1 | $115.00 | $115.00 |
| 2 | Follow-up Consultation (subsequent visits for ongoing management of chronic conditions) | 11-10-00 | 4 | $95.00 | $380.00 |
| 3 | Point-of-Care Diagnostic Testing (CBC, lipid panel, liver function, renal panel, HbA1c, TSH) | 21-05-00 | 1 | $185.00 | $185.00 |
| 4 | Electrocardiogram (ECG) — 12-lead, performed and interpreted by the Doctor General Practitioner | 21-08-00 | 1 | $75.00 | $75.00 |
| 5 | Minor Office Procedure (e.g., joint injection, wound debridement, or skin lesion excision) | 31-12-00 | 1 | $210.00 | $210.00 |
| 6 | Prescription Issuance & Medication Management (including drug interaction review) | 11-15-00 | 5 | $25.00 | $125.00 |
| 7 | Referral Coordination & Specialist Liaison (within the Canada Montreal healthcare network) | 11-20-00 | 2 | $45.00 | $90.00 |
| 8 | Annual Preventive Health Screening & Wellness Assessment (Doctor General Practitioner) | 11-30-00 | 1 | $150.00 | $150.00 |
| 9 | Telemedicine / Virtual Consultation (for non-urgent follow-ups within Canada Montreal) | 11-10-05 | 2 | $65.00 | $130.00 |
| 10 | Medical Certificate / Documentation (employer, insurance, or legal purposes) | 11-40-00 | 2 | $40.00 | $80.00 |
| Subtotal (All Services): | $1,540.00 | ||||
| Quebec Sales Tax (QST) — 9.975% (where applicable): | $153.62 | ||||
| Federal Goods and Services Tax (GST) — 5% (where applicable): | $77.00 | ||||
| TOTAL ESTIMATED AMOUNT (CAD): | $1,770.62 | ||||
*Note: Services covered under the Quebec Health Insurance Plan (RAMQ) may be billed directly to the provincial insurer. The amounts above represent the full fee schedule; your supplementary private insurance (e.g., Desjardins, Sun Life, Manulife) may cover a portion or all of these costs. The Doctor General Practitioner will submit claims on your behalf where applicable.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, fees may be subject to revision in accordance with updated CMPQ fee schedules or changes in the scope of care.
- All services described herein will be performed by a board-certified Doctor General Practitioner licensed by the Quebec College of Physicians and Surgeons, operating in full compliance with the standards of practice established for the Canada Montreal region.
- Payment is due within fifteen (15) business days of the date of invoice issuance. Accepted payment methods include Interac e-Transfer, debit/credit card (Visa, Mastercard, Amex), and certified cheque payable to Montreal General Practice Clinic Inc.
- This estimate does not constitute a guarantee of specific medical outcomes. The Doctor General Practitioner reserves the right to modify the treatment plan based on clinical judgment, in which case a revised Quotation Estimate will be provided prior to any additional procedures.
- Client health information is protected under the Quebec Act Respecting the Protection of Personal Information in the Private Sector (A-38.001) and the federal Privacy Act. All records are maintained at our secure facility in Canada Montreal.
- Appointment cancellations must be made at least 24 hours in advance. Late cancellations or no-shows may incur a fee of $50.00, which is not included in this Quotation Estimate.
- Emergency or after-hours services are not covered by this estimate and will be billed separately at the applicable CMPQ emergency fee rate.
- This Quotation Estimate is non-transferable and is issued exclusively for the client named in Section 1 of this document.
By signing below, the client acknowledges receipt of this Quotation Estimate for Doctor General Practitioner services in Canada Montreal and authorizes the provider to proceed with the outlined scope of care, subject to the terms and conditions stated herein.
Client Signature & Date
Name: ______________________________
Doctor General Practitioner — Authorizing Physician
Dr. ______________, MD, FRCPC — CMPQ #45218
Montreal General Practice Clinic Inc. — Canada Montreal
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