Quotation Estimate Physiotherapist in Canada Montreal –Free Word Template Download with AI
1245 Rue Sainte-Catherine Ouest, Suite 300, Montreal, Quebec, Canada H3B 4W8
Phone: (514) 555-0192 | Email: [email protected]
Quebec College of Physiotherapists License No. QCP-2024-0871
Quotation EstimateQuotation Details
Quotation No.: QE-2025-04187
Date Issued: June 15, 2025
Valid Until: July 15, 2025
Prepared By: Dr. Marie-Claire Tremblay, M.Sc. PT
Canada Montreal Region
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Montreal, Quebec, Canada
Phone: [Client Phone Number]
Email: [Client Email Address]
Referral Source: [Referring Physician / Self-Referral]
Dear Valued Client,
Thank you for considering our Physiotherapist services at Montreal Physiotherapy & Rehabilitation Centre. This Quotation Estimate has been prepared specifically for your individualized rehabilitation needs following a comprehensive initial assessment conducted in our Canada Montreal facility. The following document outlines the scope of physiotherapy services, associated costs, and terms of engagement. Please review this Quotation Estimate carefully and do not hesitate to contact our office should you require any clarification regarding the proposed treatment plan.
Scope of Physiotherapist ServicesOur licensed Physiotherapist in Canada Montreal will provide a comprehensive, evidence-based rehabilitation program tailored to your specific diagnosis and functional goals. The services outlined in this Quotation Estimate include manual therapy, therapeutic exercise, electrotherapy modalities, gait retraining, and patient education. All treatments will be administered by a registered Physiotherapist who is a member in good standing with the Ordre des physiothérapeutes du Québec (OPQ) and fully licensed to practice in the province of Quebec, Canada.
Itemized Cost Breakdown| # | Service Description | Duration | Frequency | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Assessment & Treatment Plan by Physiotherapist | 60 minutes | One-time | $145.00 | $145.00 |
| 2 | Manual Therapy & Joint Mobilization Sessions | 45 minutes | 2x/week x 6 weeks | $120.00 | $1,440.00 |
| 3 | Therapeutic Exercise & Strengthening Program | 45 minutes | 2x/week x 6 weeks | $110.00 | $1,320.00 |
| 4 | Electrotherapy Modalities (TENS, Ultrasound, Iontophoresis) | 30 minutes | 2x/week x 4 weeks | $85.00 | $680.00 |
| 5 | Gait Analysis & Functional Mobility Training | 45 minutes | 1x/week x 4 weeks | $115.00 | $460.00 |
| 6 | Home Exercise Program Design & Patient Education | 30 minutes | One-time | $75.00 | $75.00 |
| 7 | Progress Re-Assessment & Discharge Report | 45 minutes | One-time | $100.00 | $100.00 |
| Subtotal | $4,220.00 |
| Quebec Sales Tax (QST) 5% | $211.00 |
| Harmonized Sales Tax (HST) 5% | $211.00 |
| Grand Total (CAD) | $4,642.00 |
1. Payment Schedule: A 25% deposit ($1,160.50 CAD) is required upon acceptance of this Quotation Estimate to secure your appointment schedule. The remaining balance shall be paid in two equal installments due at the midpoint and conclusion of the treatment program.
2. Accepted Payment Methods: Interac e-Transfer, Visa, Mastercard, American Express, and certified cheque. All payments are processed in Canadian Dollars (CAD).
3. Insurance & Billing: Our Physiotherapist in Canada Montreal accepts billing through major Canadian insurance providers including Sun Life, Manulife, Desjardins, and Groupama. We will submit claims directly on your behalf. Please note that this Quotation Estimate reflects full service rates; any amounts covered by your insurance plan will be deducted from your out-of-pocket responsibility.
4. Cancellation Policy: Appointments cancelled with less than 24 hours' notice will be subject to a 50% fee of the scheduled session. No-shows will be charged the full session fee as indicated in this Quotation Estimate.
5. Validity: This Quotation Estimate is valid for thirty (30) days from the date of issue. Pricing is subject to change after the expiration date due to potential adjustments in the Canada Montreal healthcare market.
6. Confidentiality: All patient information is handled in strict compliance with the Quebec Act Respecting the Protection of Personal Information in the Private Sector (Law 25) and the Canadian Personal Information Protection and Electronic Documents Act (PIPEDA).
7. Scope of Practice: All physiotherapy services are delivered in accordance with the standards set by the Ordre des physiothérapeutes du Québec. In the event of a medical emergency or condition outside the scope of physiotherapy, our Physiotherapist will refer you to the appropriate medical specialist in the Montreal, Canada region.
Acceptance & AuthorizationBy signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for Physiotherapist services at Montreal Physiotherapy & Rehabilitation Centre, Canada Montreal. The client agrees to the payment terms, cancellation policy, and all conditions outlined herein.
Client Signature: ___________________________
Printed Name: ___________________________
Date: ___________________________
Physiotherapist Signature: ___________________________
Dr. Marie-Claire Tremblay, M.Sc. PT
Date: ___________________________
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