Quotation Estimate Psychiatrist in Netherlands Amsterdam –Free Word Template Download with AI
Keizersgracht 427, 1016 GC Amsterdam, Netherlands
Phone: +31 (0)20 555 0142 | Email: [email protected]
KvK: 87654321 | IBAN: NL91 ABNA 0417 1643 00
Licensed Psychiatrist Practice – Netherlands Quotation EstimateQuotation Details
Quotation No.: QTE-2025-AMST-00487
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Hendrik van der Berg, MD, Psychiatrist
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Amsterdam, Netherlands
Insurance Provider: [Insurance Company Name]
Policy Number: [Policy Reference]
Contact: [Phone / Email]
Dear Valued Client,
Thank you for considering the professional psychiatric services offered by our practice in Netherlands Amsterdam. This Quotation Estimate has been prepared to provide you with a transparent and detailed overview of the costs associated with the psychiatric care plan recommended by our Psychiatrist, Dr. Hendrik van der Berg. All services described herein are delivered in full compliance with the Dutch Healthcare Act (Wet op de medische behandeling) and the professional standards set by the Royal Dutch Association for Psychiatry (NVP).
The following Quotation Estimate covers a comprehensive course of psychiatric treatment to be administered at our clinic located in the heart of Amsterdam, Netherlands. The Psychiatrist will conduct an initial diagnostic assessment, formulate a personalised treatment plan, and provide ongoing therapeutic sessions over the estimated duration of care. All consultations take place in a private, confidential setting in accordance with Dutch medical confidentiality regulations (medisch geheim).
| Item No. | Description of Service | Duration / Frequency | Unit Price (EUR) | Estimated Total (EUR) |
|---|---|---|---|---|
| 01 | Initial Psychiatric Consultation & Diagnostic Assessment (including medical history review, mental status examination, and diagnostic formulation) | 1 session (90 minutes) | € 185.00 | € 185.00 |
| 02 | Follow-up Psychiatric Consultations (treatment monitoring, medication adjustment, and therapeutic progress review) | 12 sessions × 50 minutes | € 145.00 | € 1,740.00 |
| 03 | Psychological Testing & Standardised Assessment (e.g., MMSE, PHQ-9, GAD-7, BDI-II, or other instruments as clinically indicated) | 1 session (60 minutes) | € 220.00 | € 220.00 |
| 04 | Psychopharmacological Management (prescription, medication review, and side-effect monitoring by the Psychiatrist) | Included in follow-up sessions | € 0.00 | € 0.00 |
| 05 | Referral Coordination & Interdisciplinary Consultation (liaison with GP, psychologist, or specialist in the Netherlands Amsterdam healthcare network) | 2 sessions (30 minutes each) | € 95.00 | € 190.00 |
| 06 | Written Treatment Report & Discharge Summary (formal psychiatric report for insurance, employer, or legal purposes) | 1 document | € 120.00 | € 120.00 |
| 07 | Urgent / Out-of-Hours Psychiatric Consultation (if required, subject to availability in Amsterdam) | Up to 2 sessions (30 minutes each) | € 165.00 | € 330.00 |
| TOTAL ESTIMATED COST (excl. 9% BTW / VAT) | € 2,785.00 | |||
| VAT (BTW) 9% | € 250.65 | |||
| GRAND TOTAL (incl. 9% BTW / VAT) | € 3,035.65 | |||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision in line with the Dutch healthcare fee schedule (Tarievenlijst GGZ).
- Payment is due within fourteen (14) days of the invoice date. Invoices are issued per session or per monthly cycle, as agreed upon in the treatment plan.
- If the client holds a Dutch health insurance policy (zorgverzekering) with a supplementary psychiatric care component (GGZ-verzekering), the Psychiatrist will submit the claim directly to the insurance provider. The client is responsible for any applicable deductible (eigen risico) and co-payment (medisch overleg / eigen bijdrage).
- For clients without Dutch insurance coverage, the full amounts listed in this Quotation Estimate apply. A 10% deposit is required to confirm the initial appointment.
- 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.
- All services are provided in the Netherlands, specifically at our clinic in Amsterdam. The Psychiatrist is registered with the Dutch Medical Council (BIG-register) and holds a valid licence to practise psychiatry in the Netherlands.
- This Quotation Estimate does not constitute a binding contract. A formal treatment agreement (behandelovereenkomst) will be signed prior to the commencement of care, in accordance with Dutch healthcare legislation.
- Confidentiality: All medical information is handled in strict accordance with the Dutch Medical Treatment of Adults Act (Wet medisch behandeling volwassene) and the General Data Protection Regulation (GDPR / AVG).
- Any additional services not explicitly listed in this Quotation Estimate will be communicated to the client in writing before they are provided, with a supplementary cost estimate.
By signing below, the client acknowledges receipt of this Quotation Estimate for psychiatric services in Netherlands Amsterdam and agrees to the terms and conditions outlined above. This signature does not yet constitute a binding treatment agreement but confirms the client's intent to proceed with the proposed care plan under the guidance of the Psychiatrist.
For the Client
Name & SignatureDate: _______________
For Amsterdam Psychiatric Care Centre
Dr. H. van der Berg, MDPsychiatrist – Netherlands Amsterdam
Date: _______________
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