Quotation Estimate Physiotherapist in South Africa Johannesburg –Free Word Template Download with AI
Professional Physiotherapist Services — South Africa Johannesburg
Ref: QE/PT/JHB/2025/0047 | Date: 15 June 2025 | Valid Until: 15 July 2025
This Quotation Estimate has been prepared by Mokoena Physiotherapy & Rehabilitation Clinic to provide Mr. James van der Merwe with a comprehensive, itemised financial breakdown for the full course of Physiotherapist-led rehabilitation services to be delivered in South Africa Johannesburg. The purpose of this document is to ensure complete transparency regarding the scope of treatment, associated costs, payment terms, and the professional obligations of both parties. This Quotation Estimate reflects the current fee schedule of our registered Physiotherapist team and is aligned with the standards set by the Health Professions Council of South Africa (HPCSA) and the South African Physiotherapy Association (SAPTA).
Following a comprehensive initial assessment conducted on 10 June 2025 at our Sandton facility in South Africa Johannesburg, the treating Physiotherapist has recommended a structured twelve-week rehabilitation programme. The scope of services included in this Quotation Estimate encompasses the following:
- Initial Comprehensive Assessment (1 × 60 min): Full musculoskeletal evaluation, gait analysis, range-of-motion testing, and functional capacity screening performed by a senior Physiotherapist.
- Manual Therapy Sessions (12 × 45 min): Joint mobilisation, soft-tissue release, myofascial therapy, and therapeutic massage administered by the assigned Physiotherapist to address the client’s chronic lower-back and right-shoulder pathology.
- Therapeutic Exercise & Rehabilitation (12 × 45 min): Individualised progressive exercise prescription, core stabilisation training, and functional movement retraining supervised by the Physiotherapist.
- Electrotherapy & Modalities (6 × 30 min): Application of therapeutic ultrasound, interferential current, and cryotherapy as adjuncts to the manual and exercise programme.
- Progress Review & Re-assessment (2 × 30 min): Mid-programme and final re-assessment by the Physiotherapist to document functional gains and adjust the treatment plan accordingly.
- Home Exercise Programme & Ergonomic Advice: Written and video-based home programme, workplace ergonomic consultation, and a follow-up telehealth check-in at six weeks post-discharge.
| Item / Service | Qty | Unit Price (ZAR) | Amount (ZAR) |
|---|---|---|---|
| Initial Comprehensive Assessment (60 min) | 1 | R 950.00 | R 950.00 |
| Manual Therapy Session (45 min) | 12 | R 750.00 | R 9 000.00 |
| Therapeutic Exercise & Rehabilitation (45 min) | 12 | R 680.00 | R 8 160.00 |
| Electrotherapy & Modalities (30 min) | 6 | R 450.00 | R 2 700.00 |
| Progress Review & Re-assessment (30 min) | 2 | R 500.00 | R 1 000.00 |
| Home Exercise Programme & Ergonomic Consultation | 1 | R 650.00 | R 650.00 |
| Follow-up Telehealth Check-in (20 min) | 1 | R 350.00 | R 350.00 |
| Subtotal | R 22 810.00 | ||
| VAT (15%) | R 3 421.50 | ||
| TOTAL (Incl. VAT) | R 26 231.50 | ||
This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Payment is due within fourteen (14) days of the final invoice date. The client may elect to pay the full amount in a single EFT transfer to the clinic’s FNB account (Account No. 6284 5512 009, Branch 250655) or opt for a three-month instalment plan of R 8 743.83 per month, subject to a one-time administrative fee of R 250.00. All fees are quoted in South African Rand (ZAR) and are inclusive of the Physiotherapist’s professional time, clinic facility usage, and standard consumables. This Quotation Estimate does not include the cost of any orthotic or assistive devices that the Physiotherapist may recommend as a separate prescription.
All Physiotherapist services described in this Quotation Estimate are delivered by HPCSA-registered practitioners (HPCSA No. 0045821) in full compliance with the Health Professions Act 56 of 1974 and the National Health Act 61 of 2003. The clinic operates in South Africa Johannesburg under a valid premises licence issued by the City of Johannesburg Health Department. Client records are maintained in accordance with the Protection of Personal Information Act (POPIA) 4 of 2013. In the event of a medical-aid claim, the Physiotherapist will submit all necessary documentation, including the treatment plan, progress notes, and itemised invoices, directly to the client’s registered scheme.
Should the client need to cancel or reschedule a booked Physiotherapist session, a minimum of twenty-four (24) hours’ written notice is required. Cancellations made within twenty-four hours or no-shows will be charged at fifty percent (50%) of the applicable session fee. In the unlikely event that the treating Physiotherapist is unavailable due to illness or leave, an equivalent-credential Physiotherapist from our South Africa Johannesburg team will be substituted at no additional cost to the client.
Note: This Quotation Estimate is a good-faith financial estimate and does not constitute a binding contract until accepted in writing by both parties. The final treatment plan may be adjusted by the treating Physiotherapist based on the client’s clinical progress, and any material change in scope will be communicated in a revised Quotation Estimate prior to implementation.By signing below, the client acknowledges receipt of this Quotation Estimate for Physiotherapist services in South Africa Johannesburg and agrees to the terms, conditions, and fee structure outlined herein.
| Client Signature | Physiotherapist / Clinic Representative |
|---|---|
|
Name: _________________________ Signature: _________________________ Date: _________________________ |
Name: Dr. Thandiwe Mokoena Signature: _________________________ Date: _________________________ |
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