Quotation Estimate Psychiatrist in Egypt Alexandria –Free Word Template Download with AI

Quotation No.: QTE-ALX-2025-04782 Date of Issue: 15 June 2025 Valid Until: 15 July 2025 Prepared By: Dr. Hana El-Sayed, MD, PhD Specialty: Psychiatrist — Clinical & Forensic Psychiatry License No.: EGY-PSY-2019-00347 Client Information

Client Name:	[Client / Organization Name]
Address:	[Street, District], Egypt Alexandria, 21411, Egypt
Contact Number:	[+20 XX XXX XXXX]
Email:	[[email protected]]
Referral Source:	Self-Referral / Insurance Provider

Scope of Psychiatrist Services — Egypt Alexandria

This Quotation Estimate is issued by the Alexandria Mental Health & Wellness Center, a licensed psychiatric practice operating in the heart of Egypt Alexandria. The following services are provided by a board-certified Psychiatrist specializing in adult and adolescent mental health, mood disorders, anxiety spectrum conditions, substance use disorders, and neurodevelopmental conditions. All clinical consultations and therapeutic interventions are conducted in compliance with the Egyptian Ministry of Health regulations and the Egyptian Medical Syndicate standards for psychiatric practice in the Alexandria Governorate.

Itemized Services and Costs

#	Service Description	Duration / Frequency	Unit Price (EGP)	Quantity	Subtotal (EGP)
1	Initial Comprehensive Psychiatric Assessment & Diagnostic Evaluation by the Psychiatrist	90 minutes (one-time)	1,500	1	1,500
2	Follow-up Psychiatric Consultation & Treatment Plan Review	45 minutes per session	1,000	12	12,000
3	Psychopharmacological Management & Medication Prescribing (including prescription renewal)	Per visit	500	12	6,000
4	Cognitive-Behavioral Therapy (CBT) Sessions conducted by the Psychiatrist or supervised clinical psychologist	60 minutes per session	1,200	16	19,200
5	Psychological Testing & Neuropsychological Battery Administration (e.g., MMSE, PHQ-9, GAD-7, BDI)	One-time assessment	2,500	1	2,500
6	Family Psychoeducation & Supportive Counseling Session	60 minutes per session	1,100	4	4,400
7	Urgent / After-Hours Psychiatric Consultation (available 7 days a week in Egypt Alexandria)	30 minutes per session	1,800	2	3,600
8	Written Medical Report & Diagnostic Certificate (for insurance, legal, or employment purposes)	Per document	800	2	1,600
9	Telepsychiatry / Video Consultation (for clients residing in outer districts of Egypt Alexandria)	45 minutes per session	900	4	3,600
TOTAL ESTIMATED COST (EGP):					54,400
VAT (14% — Egyptian Tax Authority):					7,616
GRAND TOTAL (EGP):					62,016

Note: This Quotation Estimate is a good-faith estimate of the Psychiatrist services to be rendered in Egypt Alexandria over an estimated 12-week treatment period. Actual costs may vary depending on the clinical progression, additional diagnostic needs, or changes in the treatment plan as determined by the treating Psychiatrist. All prices are quoted in Egyptian Pounds (EGP) and are subject to revision in accordance with the Egyptian Medical Syndicate fee schedule updates. Terms and Conditions

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Beyond this period, the Psychiatrist services and associated fees in Egypt Alexandria may be subject to revision.
Payment is due within fourteen (14) days of the date of this Quotation Estimate. Accepted payment methods include bank transfer (CIB, NBE, or Heliopolis Bank), cash at the Alexandria clinic office, or approved insurance reimbursement.
A 50% deposit is required to secure the initial appointment with the Psychiatrist. The remaining balance is payable upon completion of the treatment cycle or in monthly installments as agreed in writing.
All psychiatric records, diagnostic reports, and treatment notes are maintained in strict confidentiality in accordance with Egyptian Law No. 10 of 2018 on the Protection of Personal Data and the ethical code of the Egyptian Medical Syndicate.
Cancellation of a scheduled Psychiatrist session must be communicated at least 24 hours in advance. Late cancellations or no-shows will incur a 50% fee of the session cost.
The treating Psychiatrist reserves the right to modify the treatment plan, refer the client to a specialist in Egypt Alexandria, or discontinue services if clinical judgment deems it necessary for the patient's safety and well-being.
This Quotation Estimate does not constitute a binding contract until both parties have signed and dated the document. Upon acceptance, a formal Service Agreement will be executed.
The clinic is located at 42 Corniche El-Nil Street, Smouha District, Egypt Alexandria, and is accessible via public transportation. Parking is available on-site for a nominal fee.
Any disputes arising from the services described in this Quotation Estimate shall be resolved through the Egyptian Medical Syndicate arbitration panel in Alexandria before resorting to judicial proceedings.

Acceptance and Authorization

By signing below, the client acknowledges receipt of this Quotation Estimate for Psychiatrist services in Egypt Alexandria and agrees to the terms, conditions, and estimated costs outlined herein. The client confirms that they have had the opportunity to ask questions regarding the scope of services, the qualifications of the treating Psychiatrist, and the billing structure.

Client Signature
Name: _________________________
Date: _________________________ Psychiatrist / Authorized Representative
Dr. Hana El-Sayed, MD, PhD
Alexandria Mental Health & Wellness Center
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX

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