Quotation Estimate Psychiatrist in Belgium Brussels –Free Word Template Download with AI

This Quotation Estimate is issued by Dr. Elena Vandermeer, a licensed Psychiatrist registered with the Belgian Federal Health Authority (AFMPS) and the RIZIV/INAMI, for the provision of psychiatric and mental health services to the client identified above. This Quotation Estimate is valid for a period of 60 calendar days from the date of issue (15 June 2025). All prices are quoted in Euros (EUR) and are inclusive of the applicable Belgian VAT at the standard rate of 21%, unless otherwise stated. This document serves as a non-binding Quotation Estimate and does not constitute a contractual obligation until formally accepted in writing by both parties.

The following Quotation Estimate covers a comprehensive package of psychiatric services to be delivered by a qualified Psychiatrist at the practice located in the heart of Belgium Brussels, specifically in the European Quarter district. The services are designed to meet the clinical and regulatory standards set forth by the Belgian Federal Government and the Brussels-Capital Region health authority. The Psychiatrist holds a full medical licence (Licence A) and is a member of the Royal College of Psychiatrists of Belgium (Collège Royal des Psychiatres de Belgique).

• This Quotation Estimate is payable within 30 days of the date of issue via bank transfer to the account of the Psychiatrist (IBAN: BE[XX] [XXXX] [XXXX] [XXXX] [X], BIC: [XXXXBE[XX]]).
• A 10% deposit is required to confirm the booking of the initial psychiatric assessment. The remaining balance is due upon completion of the full treatment package.
• For corporate or institutional clients in Belgium Brussels, payment may be arranged through the company's health insurance provider or mutualité (mutualité) in accordance with Belgian social security regulations.
• Late payments are subject to a statutory interest rate of 10% per annum as per Belgian law (Code de droit économique, Art. 5:110).
• All services are subject to the Belgian Medical Code of Ethics and the confidentiality provisions of the Belgian Data Protection Act (Loi du 30 juillet 2018 relative à la protection des personnes physiques à l'égard du traitement des données à caractère personnel).

• This Quotation Estimate is a good-faith estimate of costs and is not a fixed-price contract. The final invoice may vary by up to 10% depending on the clinical complexity of the case and the number of sessions actually required.
• The Psychiatrist reserves the right to refer the client to a specialist centre (e.g., Hôpital Erasme, CHU Brugmann, or the Brussels University Hospital) if the clinical presentation warrants inpatient or specialised treatment. Additional costs for such referrals are not included in this Quotation Estimate.
• All consultations take place at the practice in Belgium Brussels (Avenue Louise 287, 1050 Brussels) or via secure telepsychiatry platform. Travel and accommodation costs for the client are not covered.
• Cancellation of an appointment must be made at least 48 hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee.
• This Quotation Estimate is governed by the laws of the Kingdom of Belgium. Any disputes shall be submitted to the competent courts of Brussels.
• The Psychiatrist is fully insured for professional liability (RC Professionnelle) with AXA Belgium, Policy No. AXA-BE-2025-77812.

By signing below, the client acknowledges receipt of this Quotation Estimate for Psychiatrist services in Belgium Brussels and agrees to the terms and conditions outlined herein. This acceptance does not guarantee insurance reimbursement; the client is advised to verify coverage with their mutualité prior to commencing treatment.