Quotation Estimate Physiotherapist in Australia Sydney –Free Word Template Download with AI

Quotation Estimate No.	QTE-2025-00487
Date of Issue	12 June 2025
Valid Until	12 July 2025 (30 days from date of issue)
Prepared For	Mr. James A. Whitfield, 18 Crown Street, Ultimo, Australia Sydney, NSW 2007
Prepared By	Dr. Sarah Mitchell, M.Phd (Physio), AHPRA Reg. No. PHY-2024-001234
Service Location	Sydney Physiotherapy & Rehabilitation Centre, Pyrmont, Australia Sydney

Dear Mr. Whitfield,

Thank you for contacting Sydney Physiotherapy & Rehabilitation Centre regarding your physiotherapy assessment and treatment plan. This Quotation Estimate has been prepared following your initial consultation on 5 June 2025, during which our senior Physiotherapist conducted a comprehensive musculoskeletal assessment of your lower back and right knee. The following document outlines the estimated costs for the recommended course of treatment to be delivered at our clinic in Australia Sydney.

Please note that this Quotation Estimate is a good-faith projection of fees based on the treatment plan discussed during your assessment. Actual costs may vary slightly depending on your clinical progress, the number of sessions ultimately required, and any additional modalities that may be recommended by your treating Physiotherapist during the course of care.

Itemised Services & Estimated Costs

Ref	Description of Service	Qty	Unit Price (AUD)	Estimated Total (AUD)
1	Initial Comprehensive Physiotherapy Assessment & Treatment Plan (60 minutes) – includes gait analysis, manual muscle testing, and functional movement screening	1	$185.00	$185.00
2	Follow-up Physiotherapy Treatment Sessions (45 minutes each) – manual therapy, therapeutic exercise, soft tissue mobilisation, and electrotherapy as clinically indicated	10	$145.00	$1,450.00
3	Therapeutic Exercise & Rehabilitation Program (30 minutes) – supervised progressive loading, core stabilisation, and proprioceptive training	6	$110.00	$660.00
4	Ultrasound-Guided Dry Needling & Soft Tissue Treatment (30 minutes) – targeting myofascial trigger points in lumbar paraspinals and quadriceps	4	$125.00	$500.00
5	Postural Correction & Ergonomic Workplace Assessment (45 minutes) – on-site or virtual assessment of your workstation in Australia Sydney	1	$160.00	$160.00
6	Custom Orthotic Insole Design & Fitting (60 minutes) – includes 3D foot scanning, moulding, and two follow-up adjustment appointments	1	$320.00	$320.00
7	Progress Review & Discharge Summary (30 minutes) – final functional assessment, home exercise program handout, and referral letter to your GP	1	$95.00	$95.00
Subtotal				$3,370.00
GST (10%)				$337.00
Total Estimated Amount (AUD)				$3,707.00

Notes & Clinical Context

This Quotation Estimate reflects a conservative treatment plan for your diagnosed L4-L5 disc bulge with associated right knee patellofemoral pain syndrome. Your treating Physiotherapist, Dr. Sarah Mitchell, has designed a 16-week programme combining hands-on manual therapy, progressive resistance training, and neuromuscular re-education. The estimated number of sessions may be adjusted upward or downward based on your response to treatment. Should additional sessions be required beyond those itemised above, they will be billed at the standard per-session rates listed in this document, and a supplementary Quotation Estimate will be provided for your approval prior to any additional charges.

All services are delivered by a registered and accredited Physiotherapist in compliance with the Australian Health Practitioner Regulation Agency (AHPRA) standards and the Physiotherapy Board of Australia practice standards. Our clinic in Australia Sydney is fully insured, NDIS-registered, and accepts Medicare Health Care Card concessions, private health insurance (HICAPS), and work cover claims.

Terms & Conditions of This Quotation Estimate

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, fees may be subject to revision in accordance with the Physiotherapy Board of Australia fee guidelines and prevailing Australian market rates.
Payment is due within fourteen (14) days of each treatment session unless a pre-arranged payment plan has been agreed in writing. A 2% late payment surcharge applies to accounts outstanding beyond the due date.
Cancellations must be provided at least twenty-four (24) hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee.
Medicare rebates and private health insurance claims are processed directly at the point of care via HICAPS. The patient is responsible for any gap between the insurance rebate and the fee charged by the Physiotherapist.
This Quotation Estimate does not constitute a guarantee of clinical outcomes. Treatment plans are individualised and may be modified by the treating Physiotherapist at their clinical discretion.
All personal health information collected during the course of treatment is handled in strict accordance with the Australian Privacy Act 1988 and the National Privacy Principles.
Disputes arising from this Quotation Estimate or the services described herein shall be resolved in accordance with the laws of New South Wales, Australia Sydney.
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined above. No services will commence until a signed copy is returned to the clinic.

Acceptance

I, the undersigned, acknowledge that I have received and reviewed this Quotation Estimate for physiotherapy services to be provided by a registered Physiotherapist at Sydney Physiotherapy & Rehabilitation Centre, Australia Sydney. I accept the estimated costs, terms, and conditions set out in this document and authorise the commencement of the treatment plan described herein.

Client Signature & Printed Name Date Physiotherapist Signature & AHPRA Reg. No. Date ⬇️ Download as DOCX Edit online as DOCX

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