Quotation Estimate Physiotherapist in South Africa Cape Town –Free Word Template Download with AI
Professional Physiotherapist Services — South Africa Cape Town
Document Reference: QTE-CT-2025-0487 | Valid for 30 days from date of issue
Prepared By:Cape Town Physiotherapy & Rehabilitation Centre
142 Sea Point Promenade, Sea Point
Cape Town, 8005, Western Cape, South Africa
Tel: +27 21 424 5567 | Email: [email protected] Quotation Estimate Date: 15 June 2025
Quotation Estimate No.: QTE-CT-2025-0487
Prepared For: Mr. Johan van der Merwe
Medical Aid Ref: Discovery Health #DH-882341
This Quotation Estimate has been prepared by our registered Physiotherapist team at the Cape Town Physiotherapy & Rehabilitation Centre to outline the comprehensive physiotherapy treatment plan recommended for the client following a clinical assessment conducted on 10 June 2025. As a licensed Physiotherapist operating in South Africa Cape Town, we adhere to the standards set by the Health Professions Council of South Africa (HPCSA) and the South African Physiotherapy Association (SAPTA). This Quotation Estimate covers a twelve-week structured rehabilitation programme designed to address the client's diagnosed lumbar disc herniation (L4/L5) with associated radiculopathy, as well as secondary hip flexor tightness and core instability.
The Physiotherapist assigned to this case, Ms. Thandiwe Nkosi (HPCSA Reg. No. 01234567/25), will oversee all sessions and coordinate with the client's primary care physician in Cape Town to ensure continuity of care. All services described in this Quotation Estimate are delivered at our Sea Point clinic facility in South Africa Cape Town, which is fully equipped with modern electrotherapy devices, hydrotherapy pools, and a dedicated strength and conditioning gymnasium.
| Item No. | Description of Physiotherapist Service | Frequency | Duration | Unit Cost (ZAR) | Total (ZAR) |
|---|---|---|---|---|---|
| 01 | Initial Comprehensive Physiotherapist Assessment & Treatment Plan (includes gait analysis, manual muscle testing, and functional movement screening) | Once | 60 min | R 1,250.00 | R 1,250.00 |
| 02 | Manual Therapy & Soft Tissue Mobilisation (Mulligan concepts, Graston IASTM, myofascial release) delivered by the Physiotherapist | 3x / week | 45 min | R 850.00 | R 18,360.00 |
| 03 | Therapeutic Exercise & Core Stabilisation Programme (progressive resistance training, Pilates-based rehabilitation, balance retraining) | 3x / week | 45 min | R 780.00 | R 16,848.00 |
| 04 | Electrotherapy & Modalities (TENS, interferential current, ultrasound, cryotherapy, laser therapy) administered under Physiotherapist supervision | 2x / week | 30 min | R 550.00 | R 7,920.00 |
| 05 | Hydrotherapy / Aquatic Physiotherapy Session (warm-water pool, 34°C, with Physiotherapist in-water guidance) | 1x / week | 40 min | R 950.00 | R 9,500.00 |
| 06 | Bi-Weekly Progress Review & Treatment Plan Adjustment by the Lead Physiotherapist | Every 2 weeks | 30 min | R 600.00 | R 3,600.00 |
| 07 | Final Discharge Assessment, Home Exercise Programme (HEP) booklet, and Referral Letter to GP in South Africa Cape Town | Once | 45 min | R 900.00 | R 900.00 |
| 08 | Custom Orthotic / Lumbar Support Brace (fitted and adjusted by the Physiotherapist) | Once | — | R 2,400.00 | R 2,400.00 |
| SUBTOTAL (Excl. VAT) | R 60,778.00 | ||||
| VAT @ 15% | R 9,116.70 | ||||
| GRAND TOTAL (Incl. VAT) | R 69,894.70 | ||||
This Quotation Estimate has been structured to align with the standard benefit schedules of major South African medical aid schemes, including Discovery Health, Momentum Health, and Bonitas. The Physiotherapist services listed above are submitted directly to the client's medical aid provider for pre-authorisation. The client is advised to contact their medical aid scheme prior to commencing treatment to confirm the number of covered Physiotherapist sessions and any applicable co-payment or excess amounts.
In the event that the medical aid does not cover the full amount outlined in this Quotation Estimate, the client will be responsible for the balance. Payment of the client's portion is due within 14 days of the final invoice. A 10% deposit is required to secure the initial booking and reserve the Physiotherapist's schedule for the full twelve-week programme.
Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on current South African Physiotherapy Association fee guidelines.
Cancellations: Appointments must be cancelled at least 24 hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee as outlined in this Quotation Estimate.
Scope: The Physiotherapist reserves the right to modify the treatment plan if the client's clinical condition changes. Any additional sessions beyond the twelve-week programme will be quoted separately.
Confidentiality: All patient records and clinical notes are maintained in strict accordance with the Protection of Personal Information Act (POPIA) of South Africa.
Location: All services referenced in this Quotation Estimate are rendered at our clinic in South Africa Cape Town. Home-visit Physiotherapist services are available at an additional R 350.00 per visit and are not included in this estimate.
By signing below, the client acknowledges that they have received, read, and understood this Quotation Estimate for Physiotherapist services in South Africa Cape Town. The client agrees to the terms, conditions, and pricing as set out in this document. The Physiotherapist and the Cape Town Physiotherapy & Rehabilitation Centre will commence the treatment plan within five (5) business days of receiving the signed Quotation Estimate and the required deposit.
Client SignatureName: Johan van der Merwe
Date: _______________
Name: Thandiwe Nkosi, MPhysTher
HPCSA Reg. No: 01234567/25
Date: _______________
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