Quotation Estimate Physiotherapist in Israel Jerusalem –Free Word Template Download with AI
This Quotation Estimate has been prepared to provide Mr. David Cohen with a comprehensive and transparent breakdown of the professional Physiotherapist services to be delivered at our clinic located in the heart of Israel Jerusalem. The purpose of this document is to outline the scope of treatment, the associated costs, the schedule of sessions, and all applicable terms and conditions governing the engagement. This Quotation Estimate is issued in accordance with the standards set forth by the Israel Physiotherapy Association and complies with all regulatory requirements of the Israeli Ministry of Health for outpatient rehabilitation services in the Jerusalem district.
Following a comprehensive initial assessment conducted on 10 June 2025, our senior Physiotherapist, Dr. Miriam Levi, has recommended a structured rehabilitation programme for the treatment of a chronic lower lumbar spine condition with associated sciatic nerve irritation. The treatment plan encompasses the following modalities and interventions, all to be administered at our fully equipped facility in Israel Jerusalem:
| Item No. | Service Description | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|
| 1 | Initial Comprehensive Assessment & Treatment Planning by a Licensed Physiotherapist | 1 session | 450.00 | 450.00 |
| 2 | Manual Therapy & Soft Tissue Mobilisation (45-minute session) | 12 sessions | 380.00 | 4,560.00 |
| 3 | Therapeutic Exercise & Core Stabilisation Programme (45-minute session) | 12 sessions | 350.00 | 4,200.00 |
| 4 | Electrotherapy & Ultrasound Modalities (30-minute session) | 8 sessions | 280.00 | 2,240.00 |
| 5 | Postural Re-education & Ergonomic Consultation | 2 sessions | 320.00 | 640.00 |
| 6 | Progress Review & Final Discharge Assessment by the Physiotherapist | 1 session | 400.00 | 400.00 |
| 7 | Home Exercise Programme (Printed & Digital) with Follow-up Telehealth Check-in | 1 package | 150.00 | 150.00 |
| Subtotal | 12,640.00 | |||
| VAT (18%) | 2,275.20 | |||
| Grand Total (ILS) | 14,915.20 | |||
The recommended treatment programme spans approximately eight (8) weeks, with sessions scheduled two to three times per week. All appointments will take place at our clinic in Israel Jerusalem, specifically at 42 King George Street, which is conveniently located near the central bus terminal and within walking distance of the Old City. The Physiotherapist will maintain a consistent schedule to ensure continuity of care, and rescheduling is permitted up to 24 hours in advance without additional charge. Patients are advised to arrive fifteen minutes prior to each session to complete any required intake forms and to allow the Physiotherapist adequate preparation time for the treatment room and equipment.
This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Payment may be arranged in the following manner: a deposit of twenty percent (20%) of the grand total, amounting to ILS 2,983.04, is due upon acceptance of this Quotation Estimate. The remaining balance shall be payable in two equal instalments, due at the midpoint of the treatment programme and upon completion of the final session. We accept payment via bank transfer, credit card (Visa, Mastercard), and cash. All prices are quoted in Israeli New Shekels (ILS) and are inclusive of all professional fees. Should the patient require additional sessions beyond those outlined in this Quotation Estimate, a revised estimate will be issued at the standard per-session rates of our Physiotherapist team.
5.1 This Quotation Estimate constitutes a non-binding offer and does not constitute a contract until formally accepted in writing by the patient or their authorised representative.
5.2 All services are to be performed by a licensed and registered Physiotherapist in good standing with the Israel Physiotherapy Association. The treating Physiotherapist holds a Doctor of Physical Therapy (DPT) degree and is certified in orthopaedic manual therapy.
5.3 The clinic operates in compliance with all health and safety regulations of the State of Israel, including those applicable to the Jerusalem municipality. Full insurance coverage is maintained for all patient interactions.
5.4 Cancellations made less than twenty-four (24) hours before a scheduled session will incur a fee of fifty percent (50%) of the session rate. No-shows will be charged the full session fee.
5.5 Patient medical records and treatment notes are handled in strict accordance with the Israeli Privacy Protection Law, 5741-1981, and the regulations of the Israeli Ministry of Health.
5.6 This Quotation Estimate does not guarantee specific medical outcomes. The Physiotherapist will adjust the treatment plan as clinically indicated based on the patient's progress and response to therapy.
By signing below, the patient acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions outlined herein. The Physiotherapist and the Jerusalem Physiotherapy & Rehabilitation Center will commence the treatment programme within five (5) business days of receiving the initial deposit.
Dr. Miriam Levi, DPT, OCSLead Physiotherapist
Jerusalem Physiotherapy & Rehabilitation Center Mr. David Cohen
Patient / Authorised Representative
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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