Quotation Estimate Midwife in Belgium Brussels –Free Word Template Download with AI
Chaussée de Waterloo 142, 1000 Brussels, Belgium
Tel: +32 2 555 0147 | Email: [email protected]
VAT No: BE 0123.456.789 | RIB: BE71 0000 0000 0000
Licensed Midwife – Ordre des Sages-Femmes de Belgique Quotation EstimateQuotation Details
Quotation No: QTE-2025-BRU-0472
Date of Issue: 15 June 2025
Valid Until: 15 September 2025
Service Location: Belgium Brussels
Currency: EUR (€)
Client Information
Name: [Client Full Name]
Address: [Street, Number]
City: 1000 Brussels, Belgium
Phone: +32 4XX XX XX XX
Email: [[email protected]]
National Register No: [SSIN Number]
This Quotation Estimate is issued by Brussels Maternal Care & Midwifery Services to provide a comprehensive and transparent breakdown of all professional Midwife services to be rendered to the client within the municipality of Belgium Brussels. The Midwife named in this document, Ms. Anne-Charlotte De Smet, holds a full licence issued by the Belgian Federal Government and is registered with the Ordre des Sages-Femmes de Belgique. All services described below comply with the current Belgian healthcare regulations, the RIZIV/INAMI reimbursement framework, and the professional code of ethics governing Midwife practice in Belgium Brussels.
The Midwife will provide continuous, evidence-based antenatal, intrapartum, and postnatal care tailored to the client's individual needs. This Quotation Estimate covers the full spectrum of care from the first antenatal consultation through to the six-week postnatal follow-up, ensuring the client receives uninterrupted Midwife support throughout the perinatal period in Belgium Brussels.
| Ref | Description of Midwife Service | Duration / Qty | Unit Price (€) | Subtotal (€) | RIZIV Reimb. |
|---|---|---|---|---|---|
| 01 | Initial antenatal consultation with the Midwife – comprehensive health assessment, medical history review, and care plan development in Belgium Brussels | 1 session (60 min) | € 85.00 | € 85.00 | € 52.00 |
| 02 | Follow-up antenatal consultations with the Midwife – fetal monitoring, growth tracking, blood pressure checks, and nutritional guidance (8 sessions) | 8 sessions (45 min each) | € 65.00 | € 520.00 | € 390.00 |
| 03 | Ultrasound coordination and referral – the Midwife arranges and accompanies the client for routine obstetric ultrasounds at a Belgium Brussels hospital | 3 referrals | € 25.00 | € 75.00 | € 0.00 |
| 04 | Birth preparation and education course – group or individual session led by the Midwife covering breathing techniques, pain management, and newborn care | 2 sessions (90 min each) | € 95.00 | € 190.00 | € 0.00 |
| 05 | Home birth attendance by the Midwife – full intrapartum care, monitoring of mother and baby, and immediate postnatal assessment at the client's residence in Belgium Brussels | 1 event (up to 12 hrs) | € 1,200.00 | € 1,200.00 | € 780.00 |
| 06 | Postnatal home visits by the Midwife – wound care, breastfeeding support, newborn health checks, and maternal well-being assessment (6 visits) | 6 visits (45 min each) | € 60.00 | € 360.00 | € 270.00 |
| 07 | Emergency on-call availability – the Midwife remains reachable 24/7 during the perinatal period for urgent consultations in Belgium Brussels | 1 period (40 weeks) | € 150.00 | € 150.00 | € 0.00 |
| 08 | Administrative and documentation fees – birth certificate assistance, RIZIV/INAMI paperwork, and medical record filing | 1 package | € 45.00 | € 45.00 | € 0.00 |
| TOTAL QUOTATION ESTIMATE (before RIZIV reimbursement) | € 2,625.00 | € 1,492.00 | |||
| ESTIMATED CLIENT OUT-OF-POCKET COST | € 1,133.00 | ||||
- This Quotation Estimate is valid for a period of ninety (90) days from the date of issue. After this period, the Midwife reserves the right to revise the fees in accordance with current Belgian healthcare tariff updates.
- All Midwife services described in this Quotation Estimate are subject to the availability of the named Midwife, Ms. Anne-Charlotte De Smet, and the client's confirmed booking in writing.
- Payment of the total amount specified in this Quotation Estimate is due within thirty (30) days of the date of issue, unless otherwise agreed in writing. The client may opt for a payment plan split across the antenatal, intrapartum, and postnatal phases.
- RIZIV/INAMI reimbursement amounts listed are estimates based on the 2025 Belgian reimbursement grid. Actual reimbursement may vary depending on the client's mutualité (mutual insurance fund) and specific coverage plan.
- In the event of a medical emergency requiring transfer to a hospital in Belgium Brussels (e.g., CHU Saint-Pierre, Hôpital Erasme, or Clinique Saint-Vincent de Paul), the Midwife will coordinate the transfer. Hospital fees are not included in this Quotation Estimate and will be billed separately by the relevant institution.
- The client is required to provide a valid Belgian national register number (SSIN) and mutualité card to facilitate RIZIV reimbursement processing by the Midwife's office.
- Cancellation of any scheduled Midwife appointment must be communicated at least 48 hours in advance. Late cancellations or no-shows may incur a fee of 50% of the session price as stated in this Quotation Estimate.
- All personal health data collected by the Midwife in Belgium Brussels is processed in strict compliance with the Belgian Data Protection Act (Loi du 30 juillet 2018) and the EU General Data Protection Regulation (GDPR).
- This Quotation Estimate does not constitute a binding contract until signed and countersigned by both parties. The Midwife's professional liability is covered by a professional indemnity insurance policy held with a Belgian insurer, as required by law.
- Any disputes arising from the services described in this Quotation Estimate shall be resolved under the jurisdiction of the competent courts of Brussels, Belgium.
By signing below, both parties acknowledge that they have read, understood, and agree to the terms set forth in this Quotation Estimate for Midwife services in Belgium Brussels.
For Brussels Maternal Care & Midwifery ServicesMs. Anne-Charlotte De Smet, Licensed Midwife
Date: ______________________ For the Client
[Client Full Name]
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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