Quotation Estimate Occupational Therapist in United States Houston –Free Word Template Download with AI
4820 Westheimer Road, Suite 310, Houston, Texas 77056, United States
Phone: (713) 555-0142 | Email: [email protected]
Texas State License No. OT-2024-88731 | NPI: 1740298356
Quotation EstimateQuotation Details
Quotation Estimate No.: QTE-2025-0417-HOU
Date of Issue: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Service Location: Houston, United States
Prepared For
Client Name: [Client / Facility Name]
Address: [Street Address], Houston, TX 77001, United States
Contact: [Phone Number]
Email: [Email Address]
This Quotation Estimate is issued by Bayou City Rehabilitation & Therapy Center to provide a comprehensive and transparent cost breakdown for professional Occupational Therapist services to be delivered within the greater United States Houston metropolitan area. This document outlines the scope of services, associated fees, and terms governing the engagement. All pricing reflects current market rates for licensed Occupational Therapist professionals operating in the Houston, Texas region of the United States.
Scope of Occupational Therapist ServicesThe following Quotation Estimate covers a full course of Occupational Therapist intervention tailored to the client's specific functional needs. Services will be administered by a board-certified Occupational Therapist (OT) or Occupational Therapist Assistant (OTA) under the supervision of a licensed OT, in compliance with all regulations set forth by the Texas State Board of Occupational Therapy and applicable federal standards within the United States.
Itemized Cost Breakdown| # | Service Description | Duration / Frequency | Unit Rate (USD) | Quantity | Subtotal (USD) |
|---|---|---|---|---|---|
| 1 | Initial Occupational Therapist Comprehensive Assessment & Evaluation (including ADL analysis, cognitive screening, and goal-setting session) | 90 minutes | $285.00 | 1 | $285.00 |
| 2 | Individual Occupational Therapist Treatment Sessions (hand therapy, fine motor retraining, adaptive equipment training, and functional task practice) | 60 minutes | $195.00 | 24 | $4,680.00 |
| 3 | Group Occupational Therapist Program (community reintegration, work simulation, and social skills training in a small group of 4–6 participants) | 90 minutes | $145.00 | 12 | $1,740.00 |
| 4 | Home & Workplace Environmental Assessment by Occupational Therapist (on-site visit within Houston, United States service area) | 2 hours | $320.00 | 2 | $640.00 |
| 5 | Adaptive Equipment Consultation & Prescription (splints, reachers, modified utensils, wheelchair seating evaluation) | 45 minutes | $175.00 | 3 | $525.00 |
| 6 | Progress Review & Discharge Planning Session by Occupational Therapist (includes written report and recommendations for maintenance) | 60 minutes | $210.00 | 2 | $420.00 |
| 7 | Telehealth Occupational Therapist Follow-Up Consultation (virtual session via HIPAA-compliant platform) | 30 minutes | $95.00 | 4 | $380.00 |
| 8 | Administrative & Documentation Fees (treatment notes, insurance billing coordination, and progress reports for referring physicians in the Houston, United States area) | Per session | $25.00 | 45 | $1,125.00 |
| TOTAL ESTIMATED COST | $9,795.00 | ||||
1. This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing for Occupational Therapist services may be subject to revision based on current market conditions in the United States Houston healthcare sector.
2. All Occupational Therapist services described in this Quotation Estimate will be performed by licensed professionals holding active credentials with the Texas State Board of Occupational Therapy. The treating Occupational Therapist will maintain a minimum of 5 years of clinical experience in the relevant specialty area.
3. Payment terms: A 25% deposit is due upon acceptance of this Quotation Estimate. The remaining balance is payable in monthly installments aligned with the treatment schedule. Late payments will incur a 1.5% monthly interest charge.
4. Insurance coordination: Bayou City Rehabilitation & Therapy Center will submit claims to the client's primary health insurance provider. The client is responsible for any deductibles, co-pays, or non-covered amounts. This Quotation Estimate reflects standard cash-pay rates; insurance-adjusted rates may differ.
5. Cancellation policy: Sessions must be cancelled at least 24 hours in advance. Late cancellations or no-shows will be billed at 50% of the Occupational Therapist session fee.
6. Service area: All in-person Occupational Therapist services will be conducted at our Houston, Texas facility or at the client's residence within a 25-mile radius of downtown Houston, United States. Travel beyond this radius will incur an additional mileage charge of $0.85 per mile.
7. Confidentiality: All client information will be handled in strict accordance with the Health Insurance Portability and Accountability Act (HIPAA) and Texas state privacy statutes. No Occupational Therapist records will be disclosed without written client consent.
8. This Quotation Estimate does not constitute a binding contract until signed and countersigned by both parties. Acceptance of this document authorizes the commencement of Occupational Therapist services as described herein.
Acceptance & AuthorizationBy signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for Occupational Therapist services to be provided in the Houston, United States area. The client agrees to all terms and conditions outlined above.
Client Signature
Name: ________________________
Date: ________________________
Authorized Representative – Bayou City Rehabilitation & Therapy Center
Name: Dr. Margaret Ellison, OTR/L
Date: ________________________
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