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 ByDr. Ananya Chaiwattana, MD (Psychiatry)
Lead Psychiatrist, Siam Wellness Psychiatric Clinic
Thailand Bangkok Client Acknowledgement
Mr. James R. Whitfield
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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