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Quotation Estimate Psychiatrist in Thailand Bangkok –Free Word Template Download with AI

Siam Wellness Psychiatric Clinic — Thailand Bangkok

Quotation Estimate No.: QTE-2025-BKK-04782

Date of Issue: 15 June 2025

Valid Until: 15 July 2025

Prepared By: Dr. Ananya Chaiwattana, MD (Psychiatry)

Clinic Address: 88 Sukhumvit Road, Khlong Toei, Bangkok 10110, Thailand

Contact: +66 2 255 8800 | [email protected]

1. Purpose of This Quotation Estimate

This Quotation Estimate document is issued by Siam Wellness Psychiatric Clinic, a licensed and accredited psychiatric practice located in the heart of Thailand Bangkok, to provide a comprehensive and transparent breakdown of all anticipated costs associated with Psychiatrist-led consultation, diagnosis, and ongoing treatment services. This Quotation Estimate is prepared specifically for the client identified below and reflects the current fee schedule of our Psychiatrist team as of the date of issue. All pricing is quoted in Thai Baht (THB) and is subject to the terms and conditions outlined in Section 7 of this document.

2. Client Information

Field Details
Client Name Mr. James R. Whitfield
Passport / ID No. GB-558291047
Residence Thailand Bangkok, Watthana District
Referring Physician Dr. Somchai Prasert, Bangkok Hospital
Insurance Provider AXA Global Health (Policy No. AXA-TH-2024-11893)

3. Scope of Psychiatrist Services

The following Psychiatrist services are included in this Quotation Estimate. Each service is delivered by a board-certified Psychiatrist registered with the Thai Medical Council and experienced in treating both local and international patients in the Thailand Bangkok metropolitan area. The scope encompasses initial assessment, diagnostic workup, pharmacological management, psychotherapy, and follow-up care.

4. Itemised Cost Breakdown

Item No. Psychiatrist Service Description Duration / Frequency Unit Price (THB) Quantity Subtotal (THB)
01 Initial Psychiatrist Consultation & Comprehensive Psychiatric Assessment (includes medical history review, mental status examination, and risk assessment) 90 minutes 4,500 1 4,500
02 Diagnostic Psychological Testing & Neuropsychological Battery (administered under Psychiatrist supervision) 3 hours 8,200 1 8,200
03 Follow-up Psychiatrist Consultation (treatment plan review, medication adjustment, progress monitoring) 45 minutes 3,200 6 19,200
04 Cognitive Behavioural Therapy (CBT) Sessions conducted by a Psychiatrist or supervised clinical psychologist 60 minutes 2,800 12 33,600
05 Psychopharmacological Management & Prescription Renewal (including drug interaction screening and lab monitoring) 30 minutes 1,800 6 10,800
06 Urgent / After-Hours Psychiatrist Telehealth Consultation (available 24/7 via secure video link for Thailand Bangkok residents) 30 minutes 2,500 2 5,000
07 Psychiatric Medication Supply (3-month course, including SSRIs, mood stabilisers, and adjunctive agents as prescribed by the Psychiatrist) 90 days 12,500 1 12,500
08 Family / Caregiver Psychoeducation Session (delivered by the treating Psychiatrist to support the patient's network in Thailand Bangkok) 60 minutes 3,500 2 7,000
09 Comprehensive Discharge Summary & Ongoing Care Plan (written report in English and Thai, suitable for international insurance claims) One-time 2,000 1 2,000
TOTAL ESTIMATED COST 102,800 THB

5. Additional Notes on Psychiatrist Services in Thailand Bangkok

Siam Wellness Psychiatric Clinic operates in full compliance with the Thai Medical Council regulations and the Ministry of Public Health guidelines governing psychiatric practice in Thailand Bangkok. All Psychiatrist consultations are conducted in a confidential, culturally sensitive environment. Our Psychiatrist team is fluent in English, Thai, and Mandarin, ensuring that international patients residing in Thailand Bangkok receive clear and accessible care. This Quotation Estimate assumes standard outpatient services; should inpatient psychiatric admission become clinically necessary, a separate and revised Quotation Estimate will be issued prior to any admission.

6. Payment Terms

Payment for the services outlined in this Quotation Estimate may be made via bank transfer to the clinic's designated account, credit/debit card (Visa, Mastercard, JCB), or directly through the client's insurance provider where pre-authorisation has been obtained. A 50% deposit is required to confirm the initial Psychiatrist appointment. The remaining balance is due within 14 days of the final service delivery. Late payments are subject to a 2% monthly surcharge. All invoices will reference this Quotation Estimate number (QTE-2025-BKK-04782) for reconciliation purposes.

7. Terms, Conditions & Validity

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to revision should the Thai Baht experience significant fluctuation or if the scope of Psychiatrist services is materially altered at the client's request. This Quotation Estimate does not constitute a binding contract until both parties have signed and returned a copy. The treating Psychiatrist reserves the right to modify the treatment plan based on clinical judgement, in which case a supplementary Quotation Estimate will be provided for the client's approval before any additional services are rendered. All patient records are maintained in accordance with Thailand's Personal Data Protection Act (PDPA) B.E. 2562 (2019).

Important Notice: This Quotation Estimate is a good-faith estimate of Psychiatrist services and is not a guarantee of final cost. Actual charges may vary depending on the clinical course of treatment, the number of follow-up Psychiatrist visits required, and any additional diagnostic or therapeutic interventions deemed necessary by the treating Psychiatrist in Thailand Bangkok. The client acknowledges that psychiatric care is iterative and that the treatment timeline may extend beyond the initial estimate period.

Prepared & Issued By
Dr. Ananya Chaiwattana, MD (Psychiatry)
Lead Psychiatrist, Siam Wellness Psychiatric Clinic
Thailand Bangkok
Client Acknowledgement
Mr. James R. Whitfield
Date: _________________________

Siam Wellness Psychiatric Clinic • 88 Sukhumvit Road, Khlong Toei, Bangkok 10110, Thailand

Thai Medical Council License No. 11-2019-00452 • VAT Reg. No. 0105559001234

This Quotation Estimate document was generated on 15 June 2025. For queries regarding this Psychiatrist service estimate in Thailand Bangkok, please contact our billing office at +66 2 255 8800 ext. 4.

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