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Quotation Estimate Occupational Therapist in Canada Toronto –Free Word Template Download with AI

Occupational Therapist Professional Services Serving the Greater Canada Toronto Region Provider:
Maple Leaf Occupational Therapy Group Inc.
2200 Yonge Street, Suite 450
Toronto, Ontario, Canada M4P 1E8
Phone: (416) 555-0142
Email: [email protected]
Business No.: 123456789 RT0001
Quotation Estimate Details:
Quotation No.: QTE-2025-07842
Date Issued: June 15, 2025
Valid Until: July 15, 2025
Prepared By: Sarah Chen, MSc OT, COT
License No.: ON-OT-48291
Client Information
Field Details
Client Name James R. Whitfield
Address 1847 Bloor Street West, Unit 312, Toronto, Ontario, Canada M6M 3Y9
Referring Physician Dr. Anita Patel, MD – Toronto General Hospital
Insurance / Funding Source Ontario Health Insurance Plan (OHIP) + Private Supplemental (Sun Life)
Service Location Canada Toronto – In-Home and Clinic-Based (North York / Downtown)
Scope of Services – Occupational Therapist Assessment and Treatment Plan

This Quotation Estimate outlines the comprehensive professional services to be delivered by a licensed Occupational Therapist operating within the Canada Toronto metropolitan area. The Occupational Therapist will conduct a full functional assessment, develop an individualized treatment plan, and provide ongoing therapeutic interventions tailored to the client's specific needs. All services comply with the standards set forth by the College of Physiotherapists and Occupational Therapists of Ontario and adhere to the regulatory framework governing allied health professionals in Canada Toronto.

The Occupational Therapist assigned to this case will hold a current Ontario College of Occupational Therapists (OCOT) license and possess a minimum of eight years of clinical experience in adult rehabilitation, hand therapy, and community reintegration within the Canada Toronto healthcare ecosystem.

Itemized Quotation Estimate Breakdown
Item # Description of Service Duration / Qty Unit Rate (CAD) Subtotal (CAD)
1 Initial Comprehensive Occupational Therapist Assessment (home visit, Canada Toronto) 1 session / 90 min $285.00 $285.00
2 Functional Capacity Evaluation and ADL/LAD Analysis 1 session / 60 min $220.00 $220.00
3 Individualized Treatment Plan Development and Care Coordination 1 deliverable $175.00 $175.00
4 Occupational Therapist Direct Treatment Sessions (hand therapy, fine motor, cognitive) 12 sessions / 45 min each $195.00 $2,340.00
5 Home Environment Assessment and Adaptive Equipment Recommendation (Canada Toronto) 1 visit / 60 min $210.00 $210.00
6 Adaptive Equipment Procurement and Fitting (splints, reachers, modified utensils) 1 package $450.00 $450.00
7 Progress Review and Discharge Summary (Occupational Therapist report) 1 session / 45 min $165.00 $165.00
8 Travel and Transportation Surcharge (within Canada Toronto city limits) Per visit $25.00 $200.00
Subtotal (before tax) $4,045.00
HST (13% – Ontario, Canada) $525.85
TOTAL QUOTATION ESTIMATE (CAD) $4,570.85
Terms and Conditions of This Quotation Estimate
  • Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, the Occupational Therapist service rates and availability may be subject to revision.
  • Payment Terms: A deposit of 25% of the total Quotation Estimate amount is due upon acceptance. The remaining balance is payable within fourteen (14) days of service completion. Payments may be made via EFT, Interac e-Transfer, or certified cheque to Maple Leaf Occupational Therapy Group Inc.
  • Insurance Reimbursement: The client is responsible for coordinating all insurance claims with OHIP and their private supplemental provider. The Occupational Therapist will provide detailed itemized receipts and clinical documentation to support reimbursement requests within the Canada Toronto healthcare system.
  • Cancellation Policy: Sessions cancelled with less than 24 hours' notice will be billed at 50% of the scheduled Occupational Therapist session fee. No-shows will be billed in full.
  • Scope Limitations: This Quotation Estimate covers the services explicitly listed above. Any additional Occupational Therapist interventions, emergency visits, or extended treatment beyond the 12-session plan will require a separate written amendment to this Quotation Estimate.
  • Regulatory Compliance: All services are delivered in accordance with the Health Professions Act (Ontario), the Occupational Therapy Practice Standards, and the privacy requirements of PHIPA (Personal Health Information Protection Act) applicable in Canada Toronto.
  • Confidentiality: All clinical records, assessment data, and treatment notes generated by the Occupational Therapist will be stored securely in compliance with Ontario's health information privacy legislation.
  • Dispute Resolution: Any disputes arising from this Quotation Estimate shall be resolved through mediation in accordance with the laws of the Province of Ontario, Canada Toronto jurisdiction.
Acceptance and Authorization

By signing below, the client acknowledges receipt of this Quotation Estimate for Occupational Therapist services in Canada Toronto and authorizes the commencement of the outlined treatment plan. The client confirms that all information provided is accurate and consents to the delivery of services as described herein.

Client Signature:

______________________________
Name: James R. Whitfield
Date: ________________________
Occupational Therapist / Provider Signature:

______________________________
Name: Sarah Chen, MSc OT, COT
Date: ________________________

Maple Leaf Occupational Therapy Group Inc. | 2200 Yonge Street, Suite 450, Toronto, Ontario, Canada M4P 1E8
This Quotation Estimate document is generated for the Canada Toronto service region. All rates are in Canadian Dollars (CAD).
Document Reference: QTE-2025-07842 | Page 1 of 1

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