Quotation Estimate Physiotherapist in France Paris –Free Word Template Download with AI
Cabinet de Kinésithérapie du Marais
12 Rue de Turenne, 75003 Paris, France
Tel: +33 1 42 55 78 90 | Email: [email protected]
SIRET: 842 567 891 00012 | ADELI: 7593012345
Quotation Estimate Details
Quotation Estimate No.: QE-2025-0487
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Claire Fontaine, DPT, Physiotherapist
Client Information
Client Name: M. Jean-Luc Moreau
Address: 45 Avenue des Champs-Élysées, 75008 Paris, France
Phone: +33 6 12 34 56 78
Email: [email protected]
Insurance: CPAM + Mutuelle AXA (N° 784521)
1. Purpose of This Quotation EstimateThis Quotation Estimate is issued by Cabinet de Kinésithérapie du Marais, a registered and licensed Physiotherapist practice operating in France Paris, to provide M. Jean-Luc Moreau with a comprehensive and transparent breakdown of the estimated costs for a course of physiotherapy treatment. This document serves as a formal Quotation Estimate outlining the scope of services, associated fees, and applicable reimbursement terms under the French healthcare system. All pricing in this Quotation Estimate reflects the current regulatory tariffs established by the French Ministry of Health for Physiotherapist services delivered in the France Paris metropolitan area.
2. Clinical Assessment SummaryFollowing an initial consultation conducted on 10 June 2025 at our France Paris clinic, the treating Physiotherapist identified the following conditions requiring intervention: post-operative rehabilitation following total knee arthroplasty (left knee), chronic lumbar disc herniation (L4-L5), and progressive loss of upper extremity mobility secondary to a rotator cuff injury. The Physiotherapist has recommended a structured 12-week treatment programme comprising manual therapy, therapeutic exercise, electrotherapy, and functional re-education. This Quotation Estimate covers the full duration of the recommended programme.
3. Itemised Services and Costs| Ref | Service Description | Frequency | Duration | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 01 | Initial comprehensive assessment and treatment plan formulation by the Physiotherapist | 1 session | 60 min | 70.00 | 70.00 |
| 02 | Manual therapy and joint mobilisation (knee and lumbar spine) | 2x / week | 30 min | 52.00 | 1,248.00 |
| 03 | Therapeutic exercise and functional re-education programme | 2x / week | 30 min | 52.00 | 1,248.00 |
| 04 | Electrotherapy (TENS, ultrasound, and interferential current) | 1x / week | 20 min | 38.00 | 456.00 |
| 05 | Rotator cuff rehabilitation and upper limb strengthening | 1x / week | 30 min | 52.00 | 624.00 |
| 06 | Progress review and treatment plan adjustment by the Physiotherapist | Monthly | 30 min | 45.00 | 135.00 |
| 07 | Home exercise programme design and patient education materials | 1 session | 30 min | 40.00 | 40.00 |
| 08 | Final discharge assessment and return-to-activity certification | 1 session | 45 min | 65.00 | 65.00 |
| SUBTOTAL (12-week programme) | 3,886.00 | ||||
| Estimated CPAM reimbursement (70% of base tariff) | -2,630.20 | ||||
| Estimated Mutuelle AXA supplementary coverage (80% of remainder) | -804.56 | ||||
| ESTIMATED PATIENT OUT-OF-POCKET COST | 451.24 | ||||
Please note that the reimbursement figures in this Quotation Estimate are estimates based on the current 2025 French national health insurance (Assurance Maladie) tariffs applicable to Physiotherapist consultations in the France Paris region (Île-de-France). The actual reimbursement amount may vary depending on the specific terms of your Mutuelle AXA contract, any applicable franchise, or changes in regulatory tariffs. The Physiotherapist at our France Paris clinic will provide you with an official attestation de soins for each session to facilitate your insurance claims. This Quotation Estimate does not constitute a guarantee of reimbursement amounts.
5. Terms and Conditions of This Quotation Estimate- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, the Physiotherapist reserves the right to revise pricing in accordance with any updated French regulatory tariffs.
- All services described in this Quotation Estimate must be performed by the treating Physiotherapist or a qualified colleague within the Cabinet de Kinésithérapie du Marais practice in France Paris.
- A valid medical prescription (ordonnance) from a licensed physician is required prior to the commencement of any treatment session covered by this Quotation Estimate.
- Appointments must be cancelled or rescheduled at least 24 hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee as stated in this Quotation Estimate.
- The total cost indicated in this Quotation Estimate is subject to modification should the treating Physiotherapist determine, in clinical judgement, that additional sessions or alternative modalities are required beyond the 12-week programme.
- Payment is due at the time of each session. The Physiotherapist accepts cash, bank card, and direct third-party payment (tiers payant) where applicable under French regulations.
- This Quotation Estimate is non-transferable and is issued exclusively to the named client for treatment at our France Paris location.
- All patient data processed in connection with this Quotation Estimate and the associated treatment is handled in strict compliance with the French Data Protection Act and the EU General Data Protection Regulation (GDPR).
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the estimated costs and reimbursement terms for Physiotherapist services in France Paris, and authorises the commencement of the treatment programme as described herein.
Client Signature
Name: M. Jean-Luc Moreau
Date: ____________________
Signature: ____________________
Physiotherapist / Practice Representative
Name: Dr. Claire Fontaine, DPT
Date: ____________________
Signature: ____________________
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