Quotation Estimate Psychiatrist in India New Delhi –Free Word Template Download with AI
MindCare Psychiatry Clinic, 42, Connaught Place, New Delhi, India – 110001
Phone: +91-11-4567-8900 | Email: [email protected]
Registration No.: DL/PSY/2024/00382 | GSTIN: 07AABCM1234F1Z5
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days) Prepared For:
Mr. Rajesh Kumar Sharma
18, Vasant Vihar, New Delhi, India – 110057
Phone: +91-98765-43210
Email: [email protected] 1. SCOPE OF SERVICES – PSYCHIATRIST CONSULTATION & TREATMENT PLAN
This Quotation Estimate is issued by MindCare Psychiatry Clinic, a registered and licensed psychiatric practice located in New Delhi, India, to provide a comprehensive breakdown of costs associated with the services of a qualified Psychiatrist for the client named above. The services outlined below are designed to address the client's diagnosed condition of Generalized Anxiety Disorder (GAD) with comorbid mild depressive episodes, as assessed during the initial screening consultation conducted on 02 June 2025. All psychiatric services will be delivered in accordance with the standards set by the Medical Council of India (MCI) and the Mental Healthcare Act, 2017 of India.
2. ITEMIZED COST BREAKDOWN| S.No. | Description of Psychiatrist Service | Duration / Qty | Unit Rate (INR) | Amount (INR) | Remarks |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychiatric Evaluation by Senior Psychiatrist (Dr. Ananya Mehta, MD, DABPN) | 1 session (90 min) | ₹ 3,500 | ₹ 3,500 | Includes clinical interview, mental status examination, and diagnostic assessment |
| 2 | Follow-up Psychiatric Consultation (Monthly) | 6 sessions (45 min each) | ₹ 2,500 | ₹ 15,000 | Progress review, medication adjustment, and therapeutic guidance |
| 3 | Cognitive Behavioural Therapy (CBT) – Individual Sessions | 12 sessions (60 min each) | ₹ 2,000 | ₹ 24,000 | Delivered by a licensed clinical psychologist under Psychiatrist supervision |
| 4 | Psychiatric Medication Prescription & Dispensing (3-month supply) | 3 months | ₹ 4,500 | ₹ 4,500 | Includes SSRIs and adjunctive agents as prescribed by the Psychiatrist |
| 5 | Psychological Assessment & Standardized Testing (BAI, BDI-II, PHQ-9, GAD-7) | 1 package | ₹ 5,000 | ₹ 5,000 | Pre-treatment and post-treatment baseline and outcome measurement |
| 6 | Family Psychoeducation Session (for immediate family members) | 2 sessions (90 min each) | ₹ 3,000 | ₹ 6,000 | Conducted by the treating Psychiatrist to support home environment |
| 7 | Emergency / After-hours Psychiatrist Tele-consultation (if required) | Up to 2 sessions | ₹ 1,500 | ₹ 3,000 | Available via phone/video for urgent psychiatric concerns in New Delhi |
| 8 | Medical Records Maintenance & Confidential File Management | 1 year | ₹ 1,000 | ₹ 1,000 | Digital and physical records stored per Indian data protection norms |
| 9 | Referral Coordination (if specialist input from neurologist or endocrinologist is needed) | 1 instance | ₹ 800 | ₹ 800 | Administrative coordination fee only; specialist fees billed separately |
| Subtotal (INR): | ₹ 62,800 | ||||
| GST @ 18% (as applicable on psychiatric services in India): | ₹ 11,304 | ||||
| GRAND TOTAL (INR): | ₹ 74,104 | INR Seventy-Four Thousand One Hundred and Four Only | |||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Beyond this period, rates may be revised based on prevailing market conditions in New Delhi, India.
- All psychiatric services will be rendered by a registered Psychiatrist holding valid MCI/State Medical Council registration. The treating Psychiatrist for this engagement is Dr. Ananya Mehta, MD (Psychiatry), DABPN.
- Payment is due within fifteen (15) days of the date of this Quotation Estimate. A 50% advance payment is required to confirm the treatment schedule and reserve the Psychiatrist's calendar in New Delhi.
- Accepted payment modes: NEFT/RTGS, UPI, Bank Transfer, Credit/Debit Card, and Cheque (drawn on any bank branch in New Delhi, India). Cash payments above ₹50,000 are not accepted as per Indian Income Tax regulations.
- Cancellation or rescheduling of any Psychiatrist consultation or therapy session must be communicated at least 24 hours in advance. Late cancellations will be charged at 50% of the session fee.
- All patient information and psychiatric records are protected under the Mental Healthcare Act, 2017, and the Digital Personal Data Protection Act, 2023 of India. No information will be disclosed without written consent of the patient or a valid court order.
- This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. The treating Psychiatrist will exercise professional judgment in adjusting the treatment plan as the patient's condition evolves.
- Any services beyond the scope defined in this estimate (e.g., inpatient psychiatric admission, ECT, or additional specialist referrals) will require a separate written Quotation Estimate and client authorization.
- Disputes, if any, arising from this Quotation Estimate shall be subject to the exclusive jurisdiction of the civil courts in New Delhi, India.
By signing below, the client acknowledges receipt of this Quotation Estimate for Psychiatrist services in New Delhi, India, and agrees to the terms, conditions, and pricing outlined herein. The client confirms that they have had the opportunity to review the scope of psychiatric services and the associated costs before providing written consent.
For MindCare Psychiatry Clinic, New Delhi, IndiaDr. Ananya Mehta, MD, DABPN
Senior Psychiatrist & Medical Director
Date: _______________ Client / Authorized Signatory
Mr. Rajesh Kumar Sharma
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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