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Quotation Estimate Physiotherapist in Japan Tokyo –Free Word Template Download with AI

Professional Physiotherapist Services — Japan Tokyo
Quotation Estimate No.: QTE-TOKYO-2025-04782 Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days) Currency: Japanese Yen (JPY)
Prepared By: Dr. Kenji Tanaka, Licensed Physiotherapist License No.: PT-JP-2019-00347
Clinic Address: Shinjuku Wellness Physiotherapy Center, 4-2-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan Tokyo
Client Name: [Client / Organization Name to be inserted]
1. Purpose of This Quotation Estimate

This Quotation Estimate is issued by Shinjuku Wellness Physiotherapy Center to provide a comprehensive and transparent breakdown of all professional Physiotherapist services to be delivered within the metropolitan area of Japan Tokyo. The purpose of this document is to outline the scope of physiotherapy treatment, associated costs, scheduling commitments, and all applicable terms governing the engagement. This Quotation Estimate is prepared in accordance with the standards set forth by the Japan Association of Physical Therapists and complies with all regulatory requirements of the Tokyo Metropolitan Government Health Bureau.

2. Scope of Physiotherapist Services

The following services will be provided by a certified Physiotherapist operating under the supervision and clinical protocols of our clinic located in the heart of Japan Tokyo. Each session is designed to address musculoskeletal conditions, post-surgical rehabilitation, sports injury recovery, chronic pain management, and general mobility improvement. All treatments are conducted in a fully equipped facility that meets the highest standards of clinical hygiene and patient safety as mandated for healthcare providers in the Tokyo region.

Item No. Service Description Duration Frequency Unit Price (JPY) Subtotal (JPY)
01 Initial Comprehensive Assessment & Physiotherapist Consultation 60 min 1 session 12,000 12,000
02 Manual Therapy & Joint Mobilization (per session) 45 min 10 sessions 9,500 95,000
03 Therapeutic Exercise & Strengthening Program 45 min 10 sessions 8,000 80,000
04 Electrotherapy (TENS, Ultrasound, Iontophoresis) 30 min 8 sessions 7,500 60,000
05 Post-Surgical Rehabilitation Program (Japan Tokyo protocol) 60 min 12 sessions 11,000 132,000
06 Home Exercise Prescription & Follow-Up Review 30 min 4 sessions 6,000 24,000
07 Specialist Referral Coordination (if required within Japan Tokyo network) As needed 1 time 5,000 5,000
08 Progress Documentation & Final Discharge Report 30 min 1 session 8,000 8,000
TOTAL ESTIMATED COST (before tax) 416,000
Consumption Tax (10%) 41,600
GRAND TOTAL (JPY) 457,600
3. 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. Any services commenced after the expiry date will be subject to re-evaluation and a revised Quotation Estimate will be issued.
  • All Physiotherapist services described herein are to be performed at our clinic premises in Shinjuku-ku, Japan Tokyo, unless a home-visit arrangement is separately agreed upon in writing (an additional travel surcharge of JPY 3,000 per visit will apply).
  • Payment is due within fourteen (14) days of the date of this Quotation Estimate. Acceptable payment methods include bank transfer (to a Japanese domestic account), credit card (Visa, Mastercard, JCB), and cash at the clinic reception.
  • A 20% deposit is required to secure the client's appointment schedule with the assigned Physiotherapist. The remaining balance is payable upon completion of the treatment program.
  • Cancellations must be made at least 24 hours in advance. Late cancellations or no-shows will incur a fee of 50% of the session rate.
  • This Quotation Estimate does not constitute a medical diagnosis. The Physiotherapist reserves the right to modify the treatment plan based on clinical assessment findings during the initial consultation in Japan Tokyo.
  • All patient records and treatment data are handled in strict compliance with the Act on the Protection of Personal Information (APPI) of Japan and the Tokyo Metropolitan Medical Association's data privacy guidelines.
  • The Physiotherapist providing services holds valid professional liability insurance with a coverage limit of JPY 100,000,000, as required for all licensed practitioners operating in Japan Tokyo.
Note: This Quotation Estimate is a good-faith estimate based on the information provided by the client at the time of request. The final cost may vary slightly depending on the clinical progress of the patient, the number of additional sessions recommended by the Physiotherapist, or any changes in the treatment scope. Any such adjustments will be communicated in writing prior to additional charges being applied. 4. Acceptance and Authorization

By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms, conditions, and estimated costs outlined for the Physiotherapist services to be rendered in Japan Tokyo. This signature constitutes formal acceptance of the quotation and authorizes the clinic to schedule the treatment program accordingly.

Client / Authorized Representative Signature Name: ______________________________ Date: ______________________________ Physiotherapist / Clinic Director Signature Name: Dr. Kenji Tanaka, PT Date: ______________________________

Shinjuku Wellness Physiotherapy Center • 4-2-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan Tokyo

Tel: +81-3-5555-0142 • Email: [email protected] • License: Tokyo Metropolitan Government Medical Facility Permit No. 2019-PT-0883

This Quotation Estimate document is generated electronically and is valid without a physical seal. © 2025 Shinjuku Wellness Physiotherapy Center. All rights reserved.

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