Quotation Estimate Physiotherapist in Canada Toronto –Free Word Template Download with AI
2200 Bloor Street West, Suite 410, Toronto, Ontario, Canada M6S 1N8
Phone: (416) 555-0192 | Email: [email protected]
College of Physiotherapists of Ontario (CPO) Licensed | OHIP & Private Insurance Accepted
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-04871
Date Issued: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Prepared By: Dr. Sarah Chen, MScPT, CPO Lic. #PT-48291
Location: Canada Toronto – Bloor West Clinic
Client Information
Client Name: Mr. James A. Richardson
Address: 1450 Avenue Road, Toronto, ON M5M 4A7
Phone: (416) 555-7734
Email: [email protected]
Insurance Provider: Sun Life Financial (Group #SL-88234)
Referring Physician: Dr. Michael Torres, MD, FRCPC
This Quotation Estimate has been prepared by our licensed Physiotherapist team at Lakeshore Physiotherapy & Rehabilitation Centre, located in the heart of Canada Toronto, to provide Mr. Richardson with a comprehensive, transparent breakdown of the anticipated costs for his physiotherapy rehabilitation programme. This document serves as a formal estimate of fees and is not a binding invoice until accepted in writing by the client. All pricing reflects current rates as of the date of issue and is subject to the terms outlined below.
Scope of Physiotherapy ServicesFollowing a comprehensive initial assessment conducted by our senior Physiotherapist, Dr. Sarah Chen, on June 5, 2025, the following treatment plan has been recommended for Mr. Richardson's post-operative knee rehabilitation (right total knee arthroplasty, performed May 20, 2025). The programme is designed to restore full range of motion, strengthen quadriceps and hamstring musculature, improve gait mechanics, and return the client to independent daily activities within the Canada Toronto metropolitan area. All sessions will be delivered at our Bloor West clinic facility in Toronto, Ontario.
Itemized Cost Breakdown| Item / Service | Description | Qty | Unit Price (CAD) | Subtotal (CAD) |
|---|---|---|---|---|
| Initial Comprehensive Assessment | 60-minute evaluation including gait analysis, ROM testing, strength assessment, and treatment plan formulation by a licensed Physiotherapist | 1 | $185.00 | $185.00 |
| Manual Therapy & Joint Mobilization | 45-minute sessions focusing on knee joint mobilization, soft tissue release, and pain management techniques | 12 | $145.00 | $1,740.00 |
| Therapeutic Exercise & Strengthening | 45-minute supervised exercise sessions targeting quadriceps, hamstrings, gluteals, and core stability | 12 | $135.00 | $1,620.00 |
| Gait Training & Functional Rehabilitation | 45-minute sessions including stair negotiation, balance training, and progressive functional task practice | 8 | $140.00 | $1,120.00 |
| Therapeutic Modalities | Application of therapeutic ultrasound, electrical stimulation (TENS/EMS), cryotherapy, and laser therapy as clinically indicated | 10 | $65.00 | $650.00 |
| Home Exercise Programme (HEP) Design | Personalized written and video-based home exercise programme with follow-up telehealth check-in | 1 | $95.00 | $95.00 |
| Progress Re-Assessment | 30-minute mid-programme and final outcome assessment to document functional gains and adjust treatment plan | 2 | $110.00 | $220.00 |
| Custom Orthotic / Brace Fitting | Professional fitting and adjustment of a hinged knee brace for post-operative support | 1 | $275.00 | $275.00 |
| Administrative & Documentation Fees | Medical reports, insurance claim processing, and referral letter coordination | 1 | $50.00 | $50.00 |
| TOTAL ESTIMATED COST (CAD) | $6,055.00 | |||
This Quotation Estimate is denominated in Canadian Dollars (CAD). The total estimated cost of $6,055.00 may be reduced significantly depending on the client's insurance coverage. Our Physiotherapist team will submit all claims directly to Sun Life Financial on the client's behalf. The client is responsible for any co-payments, deductibles, or amounts exceeding the insurance benefit limit.
Accepted payment methods include Visa, Mastercard, Interac e-Transfer, and direct bank transfer. A 50% deposit is required to secure the initial assessment appointment. The remaining balance is due within 14 days of programme completion. A 1.5% monthly interest charge will apply to outstanding balances exceeding 30 days.
For clients without private insurance, our clinic in Canada Toronto offers a sliding-scale fee structure and accepts OHIP-covered services where applicable. Please contact our billing department for details.
Terms & Conditions- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be adjusted to reflect current market rates and any changes in provincial healthcare regulations in Ontario, Canada.
- All physiotherapy services will be delivered by a licensed Physiotherapist registered in good standing with the College of Physiotherapists of Ontario (CPO). The client may request a specific therapist or be assigned to the most clinically appropriate practitioner.
- The treatment plan outlined in this estimate is based on the initial clinical assessment. The Physiotherapist reserves the right to modify the programme based on the client's progress, clinical response, or any new medical findings. Any additional sessions beyond the estimated quantity will be billed at the standard per-session rates listed above.
- Appointments must be cancelled or rescheduled with a minimum of 24 hours' notice. Late cancellations or no-shows will incur a fee of 50% of the session rate.
- This estimate does not constitute a guarantee of specific clinical outcomes. The Physiotherapist will exercise professional clinical judgment throughout the course of treatment in accordance with the standards of practice established by the CPO.
- All client health information will be handled in strict compliance with the Personal Health Information Protection Act (PHIPA) of Ontario and the federal Privacy Act of Canada. Records will be maintained at our Canada Toronto clinic for a minimum of seven (7) years.
- This Quotation Estimate is non-transferable and applies solely to the named client. Any changes to the client's medical condition, insurance status, or treatment goals may necessitate a revised estimate.
- By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions set forth herein. This acceptance does not obligate the clinic to provide services until the deposit has been received and the initial assessment has been completed.
Client Signature:
Mr. James A. RichardsonDate: ______________________
Physiotherapist / Authorized Representative:
Dr. Sarah Chen, MScPTCPO License #PT-48291
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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