Quotation Estimate Psychiatrist in Nepal Kathmandu –Free Word Template Download with AI
Shanti Mind & Wellness Clinic
Plot No. 47, New Baneshwor Marg, Kathmandu, Nepal
Phone: +977-1-4771234 | Email: [email protected]
License No.: NMC/PSY/2024/0891 | VAT Reg. No.: 801234567
Dear Mr. Koirala,
Thank you for your interest in the psychiatric care services offered by Shanti Mind & Wellness Clinic, Nepal Kathmandu. This Quotation Estimate has been prepared in accordance with your specific clinical needs as discussed during the preliminary telephonic consultation on 10 June 2025. The following document outlines the comprehensive scope of Psychiatrist services, associated diagnostic procedures, therapeutic interventions, and all applicable costs for your mental health treatment plan in the Nepal Kathmandu region.
The Psychiatrist at Shanti Mind & Wellness Clinic will provide the following clinical services as part of this Quotation Estimate. All consultations and treatments will be conducted at our Nepal Kathmandu facility located in New Baneshwor, ensuring accessibility and a culturally sensitive environment for the patient and family members.
| S.No. | Service / Item Description | Quantity | Unit Rate (NPR) | Amount (NPR) | Remarks |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychiatrist Consultation (90 minutes) – includes full psychiatric history, mental status examination, and initial diagnostic assessment | 1 session | 3,500 | 3,500 | Conducted by Dr. Anisha Shrestha |
| 2 | Follow-up Psychiatrist Consultation (45 minutes each) – ongoing medication management, symptom tracking, and treatment plan adjustment | 6 sessions | 2,500 | 15,000 | Bi-weekly over 3 months |
| 3 | Cognitive Behavioral Therapy (CBT) – structured psychotherapy sessions administered by a licensed clinical psychologist under Psychiatrist supervision | 12 sessions | 2,000 | 24,000 | Weekly, 50 min each |
| 4 | Psychological Assessment Battery – includes MMSE, PHQ-9, GAD-7, BDI, and BAI standardized instruments administered and interpreted by the Psychiatrist | 1 package | 5,500 | 5,500 | Report delivered within 5 working days |
| 5 | Psychopharmacological Prescription & Medication Guidance – initial and follow-up prescriptions, dosage titration, and side-effect monitoring by the Psychiatrist | 7 visits | 1,000 | 7,000 | Included with consultations |
| 6 | Family Psychoeducation Session – one dedicated session for up to 4 family members to understand the diagnosis, treatment adherence, and home-care strategies | 1 session | 3,000 | 3,000 | 90 minutes, Nepal Kathmandu clinic |
| 7 | Emergency Psychiatrist Consultation (after-hours) – available 24/7 for acute psychiatric crises, suicidal ideation, or severe psychotic episodes | As needed (max 2) | 5,000 | 10,000 | Charged only if utilized |
| 8 | Written Discharge / Progress Summary Report – detailed clinical summary prepared by the Psychiatrist for referral to other specialists or for employer/insurance documentation | 1 report | 1,500 | 1,500 | At end of treatment cycle |
| Subtotal | 70,000 | ||||
| VAT (13%) | 9,100 | ||||
| Grand Total (NPR) | 79,100 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, the Psychiatrist service rates may be subject to revision based on prevailing medical fee structures in Nepal Kathmandu.
- All payments shall be made in Nepalese Rupees (NPR) to Shanti Mind & Wellness Clinic, Nepal Kathmandu, via bank transfer, mobile banking (eSewa, Khalti), or cash at the clinic reception. A 20% advance payment is required to confirm the initial Psychiatrist consultation appointment.
- Remaining balance for each session shall be settled at the time of service delivery. The full CBT package (Item 3) may be paid in two equal installments: 50% at the first session and 50% at the sixth session.
- Appointments must be rescheduled at least 24 hours in advance. Cancellations made within 12 hours of a scheduled Psychiatrist consultation will incur a 50% fee of the session rate.
- The Psychiatrist reserves the right to modify the treatment plan based on clinical progress. Any additional sessions, diagnostic tests, or specialist referrals beyond the scope of this Quotation Estimate will be communicated in writing and require the client's prior consent before charges are applied.
- All medical records, consultation notes, and prescription documents generated during the course of treatment remain the property of the clinic and are maintained in strict compliance with the Nepal Health Sector Board (NHSB) data protection guidelines. The patient retains the right to access their records upon written request.
- This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. The Psychiatrist will exercise professional judgment in determining the most appropriate course of treatment for the patient's mental health condition.
- In the event of hospitalization or inpatient psychiatric care, additional charges will apply as per the prevailing rates of the affiliated hospital in Nepal Kathmandu and will be itemized in a separate Quotation Estimate prior to admission.
- Insurance claims: The clinic provides detailed invoices and medical reports suitable for submission to health insurance providers operating in Nepal. The client is responsible for verifying coverage with their insurer before commencing treatment.
- Any disputes arising from this Quotation Estimate shall be resolved amicably. In the absence of mutual resolution, the matter shall be subject to the jurisdiction of the Nepal Kathmandu District Court.
By signing below, the client acknowledges receipt of this Quotation Estimate for Psychiatrist services at Shanti Mind & Wellness Clinic, Nepal Kathmandu, and agrees to the terms and conditions outlined above.
Client SignatureMr. Rajesh Koirala
Date: _______________ Authorized Signatory – Clinic
Dr. Anisha Shrestha, MD (Psychiatry)
Shanti Mind & Wellness Clinic, Nepal Kathmandu
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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