Quotation Estimate Physiotherapist in Indonesia Jakarta –Free Word Template Download with AI
Professional Physiotherapist Services
Indonesia Jakarta — Capital Region, Indonesia
This Quotation Estimate is issued by Jakarta Physiotherapy & Rehabilitation Center to provide a comprehensive and transparent cost breakdown for professional Physiotherapist services to be delivered within the Indonesia Jakarta metropolitan area. The services outlined below are designed to address musculoskeletal conditions, post-surgical rehabilitation, sports injury recovery, chronic pain management, and neurological rehabilitation. All treatments will be administered by licensed and certified Physiotherapist professionals registered with the Indonesian Physiotherapy Association (Ikatan Fisioterapi Indonesia, IFSI) and holding valid practice permits issued by the local health authority in Indonesia Jakarta.
| No. | Service Description | Duration / Qty | Unit Price (IDR) | Subtotal (IDR) | Notes |
|---|---|---|---|---|---|
| 1 | Initial Physiotherapist Assessment & Diagnostic Evaluation | 1 session (60 min) | 1,250,000 | 1,250,000 | Includes gait analysis, ROM testing, and treatment plan |
| 2 | Manual Therapy & Joint Mobilization (Physiotherapist-led) | 10 sessions (45 min each) | 950,000 | 9,500,000 | Soft tissue mobilization, myofascial release |
| 3 | Therapeutic Exercise & Strengthening Program | 10 sessions (45 min each) | 850,000 | 8,500,000 | Individualized exercise prescription |
| 4 | Electrotherapy & Modalities (TENS, Ultrasound, IFT) | 10 sessions (30 min each) | 750,000 | 7,500,000 | Pain management and tissue healing |
| 5 | Post-Surgical Rehabilitation Program | 8 sessions (60 min each) | 1,100,000 | 8,800,000 | Progressive loading and functional restoration |
| 6 | Home Visit Physiotherapist Service (Indonesia Jakarta area) | 4 visits (60 min each) | 1,500,000 | 6,000,000 | Within 15 km radius of SCBD, Jakarta Selatan |
| 7 | Ergonomic Workplace Assessment & Consultation | 1 visit (2 hours) | 2,500,000 | 2,500,000 | Office setup review, posture correction plan |
| 8 | Follow-up Progress Review & Discharge Summary | 2 sessions (30 min each) | 600,000 | 1,200,000 | Outcome measurement and referral if needed |
| Subtotal | 45,250,000 | ||||
| VAT (PPN) 11% | 4,977,500 | ||||
| Grand Total (IDR) | 50,227,500 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Any services commenced after the expiry date will be subject to re-quotation at prevailing rates.
- All Physiotherapist services will be conducted in compliance with the standards set by the Ministry of Health of the Republic of Indonesia and the professional code of ethics of the IFSI (Ikatan Fisioterapi Indonesia).
- Payment terms: 50% deposit upon acceptance of this Quotation Estimate, with the remaining 50% payable upon completion of the treatment program. Payment may be made via bank transfer to the account of Jakarta Physiotherapy & Rehabilitation Center, Bank Mandiri, Indonesia Jakarta branch.
- Sessions must be scheduled at least 24 hours in advance. Cancellations made less than 12 hours before the scheduled session will incur a 50% fee of the session price.
- Home visit Physiotherapist services are limited to the Indonesia Jakarta metropolitan area (Jakarta Pusat, Jakarta Selatan, Jakarta Barat, Jakarta Timur, Jakarta Utara, and Jakarta Barat). Travel beyond the 15 km radius will be charged at an additional rate of IDR 50,000 per kilometer.
- The total number of sessions outlined in this Quotation Estimate is an estimate based on the initial clinical assessment. The treating Physiotherapist reserves the right to adjust the treatment plan based on the patient's progress, which may result in additional or reduced sessions. Any changes will be communicated in writing and require client approval before additional charges apply.
- All patient records and treatment documentation will be maintained in accordance with Indonesian data protection regulations (UU PDP No. 27 Tahun 2022). Confidentiality is guaranteed throughout the course of treatment and beyond.
- This Quotation Estimate does not constitute a binding contract until formally accepted in writing by both parties. Acceptance may be indicated by signing the attached acceptance form or by remitting the initial deposit.
- Any disputes arising from the services described in this Quotation Estimate shall be resolved amicably or, failing that, through the competent courts in Indonesia Jakarta, South Jakarta District Court.
By signing below, the client acknowledges receipt of this Quotation Estimate for Physiotherapist services in Indonesia Jakarta and agrees to the terms and conditions outlined above.
Prepared By (Provider)Jakarta Physiotherapy & Rehabilitation Center
Name: _________________________
Title: Lead Physiotherapist, IFSI Certified
Date: _________________________ Accepted By (Client)
Name: _________________________
Company / Organization: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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