Quotation Estimate Physiotherapist in India Mumbai –Free Word Template Download with AI

Quotation Estimate

Quotation Estimate No.	APX/PHYS/2025/00472
Date of Issue	15 June 2025
Validity Period	30 days from the date of issue (until 15 July 2025)
Client / Patient Name	Mr. Rajesh Kumar Sharma
Client Address	18, Sea Breeze Apartments, Juhu, Mumbai, Maharashtra – 400049, India
Referring Physician	Dr. Ananya Deshpande, Orthopaedic Surgeon, Lilavati Hospital, Bandra, Mumbai
Diagnosis / Condition	Post-operative knee rehabilitation (Total Knee Replacement – Left Knee), Grade II Lumbar Disc Prolapse
Mode of Service	Outpatient Physiotherapy at Apex Centre, Bandra West, Mumbai

1. Scope of Physiotherapist Services

This Quotation Estimate is issued by Apex Physiotherapy & Rehabilitation Centre, a licensed and NABH-accredited physiotherapy practice located in India Mumbai, to provide comprehensive outpatient rehabilitation services. The lead Physiotherapist assigned to this case is Mr. Vikram Nair, MPT (Orthopaedics), with over twelve years of clinical experience in post-surgical rehabilitation, sports injury management, and chronic pain therapy. All services described in this Quotation Estimate will be delivered at our Bandra West facility in Mumbai, Maharashtra, India, and are subject to the terms and conditions outlined in Section 5 below.

2. Itemised Cost Breakdown

S.No.	Service / Description	Quantity	Unit Rate (INR)	Amount (INR)	Remarks
1	Initial Comprehensive Assessment by Senior Physiotherapist (history, gait analysis, ROM testing, manual muscle grading, functional evaluation)	1 session	₹ 1,500	₹ 1,500	One-time charge
2	Individualised Physiotherapy Treatment Sessions (therapeutic exercises, manual therapy, joint mobilisation, soft-tissue techniques, gait retraining)	24 sessions	₹ 1,200	₹ 28,800	45 min per session, 3x/week
3	Electrotherapy & Modalities (TENS, IFT, Ultrasound Therapy, Laser Therapy, Cryotherapy, Hot/Cold packs as clinically indicated)	24 sessions	₹ 500	₹ 12,000	Supplementary to manual therapy
4	Home Exercise Programme (HEP) Design & Digital Follow-up (customised video-based exercise plan, WhatsApp/tele-consultation check-ins)	1 package	₹ 3,000	₹ 3,000	Valid for 8 weeks
5	Functional & Outcome Re-assessment (pre- and post-treatment comparison, gait analysis, strength re-testing, discharge summary)	2 sessions	₹ 1,000	₹ 2,000	Week 2 and Week 8
6	Physiotherapist Consultation with Referring Orthopaedic Surgeon (progress review, treatment plan adjustment)	2 sessions	₹ 800	₹ 1,600	Coordinated with Dr. Deshpande
7	Therapeutic Aids & Orthoses (knee brace, ankle weights, resistance bands, foam roller – as prescribed by the Physiotherapist)	1 set	₹ 4,500	₹ 4,500	Cost of equipment only
Subtotal				₹ 53,400
GST @ 18% (as applicable under Indian healthcare tax regulations)				₹ 9,612
Grand Total (INR)				₹ 63,012	INR Sixty-Three Thousand Twelve Only

3. Treatment Timeline

The complete rehabilitation programme outlined in this Quotation Estimate is designed to span approximately eight (8) weeks, commencing from the date of the initial assessment. The Physiotherapist will conduct three in-person treatment sessions per week at the Apex Centre in Bandra West, India Mumbai. Between scheduled visits, the patient will follow the prescribed Home Exercise Programme and receive weekly tele-consultation check-ins. The treatment plan is dynamic and may be modified by the treating Physiotherapist in consultation with the referring orthopaedic surgeon based on the patient's clinical progress. Any additional sessions beyond the 24 sessions quoted here will be billed at the standard per-session rate of ₹1,200 plus applicable modalities, and will require prior written approval from the patient.

4. Payment Terms

A non-refundable advance of 30% (₹ 18,904) of the Grand Total is due at the time of acceptance of this Quotation Estimate to confirm the booking and reserve the Physiotherapist's schedule.
The remaining 70% (₹ 44,108) shall be payable in two equal instalments: 50% at the completion of Week 4 and the balance at the final discharge assessment in Week 8.
Accepted payment modes: NEFT/RTGS, UPI (GPay, PhonePe, Paytm), credit/debit cards, and bank transfer to the account details provided on the official invoice. Cash payments above ₹50,000 are not accepted in accordance with Indian Reserve Bank guidelines.
A tax invoice with GST breakdown will be issued for each payment transaction.

5. Terms & Conditions

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Beyond this period, rates may be revised to reflect current market conditions in India Mumbai.
All services will be rendered by a qualified, registered Physiotherapist holding a valid licence from the State Rehabilitation Council, Maharashtra, and the Indian Physiotherapy Association.
The patient is expected to attend all scheduled sessions. Cancellations must be communicated at least 24 hours in advance; otherwise, 50% of the session fee will be charged.
The Physiotherapist reserves the right to modify the treatment protocol if the patient's medical condition changes, in which case a revised Quotation Estimate will be issued and must be re-accepted by the patient in writing.
Apex Physiotherapy & Rehabilitation Centre, Mumbai, India, shall not be held liable for any adverse outcomes arising from the patient's non-compliance with prescribed home exercises or failure to attend follow-up appointments with the referring surgeon.
All patient records, assessment reports, and treatment notes will be maintained in accordance with the Indian Digital Personal Data Protection Act, 2023, and the confidentiality standards of the Indian Medical Association.
This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Physiotherapist will use best clinical judgement and evidence-based practice to achieve the most favourable recovery possible.
Any disputes arising from this Quotation Estimate shall be subject to the exclusive jurisdiction of the competent courts in Mumbai, Maharashtra, India.

6. Acceptance & Authorisation

By signing below, the patient (or authorised guardian) acknowledges that they have read, understood, and accepted all terms, conditions, and cost details presented in this Quotation Estimate for Physiotherapist services to be delivered in India Mumbai.

For Apex Physiotherapy & Rehabilitation Centre
Mr. Vikram Nair, MPT (Ortho)
Lead Physiotherapist
Date: _______________ Patient / Authorised Guardian
Name: Mr. Rajesh Kumar Sharma
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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