Quotation Estimate Psychiatrist in Vietnam Ho Chi Minh City –Free Word Template Download with AI
128 Nguyen Hue Boulevard, District 1, Vietnam Ho Chi Minh City
Tel: +84 28 3822 4567 | Email: [email protected]
License No: 2019-VC-04521 | Tax Code: 0312456789
Quotation Estimate Professional Psychiatrist Consultation & Treatment ServicesQuotation Details
Quotation No: QTE-2025-HCM-00847
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Service Location: Vietnam Ho Chi Minh City
CONFIDENTIALClient Information
Client Name: [Client Full Name]
Address: [Client Address], Vietnam Ho Chi Minh City
Contact: [Phone / Email]
Referral Source: [Referring Physician / Self]
This Quotation Estimate is prepared by Saigon Mind Wellness Center to provide a comprehensive and transparent cost breakdown for professional Psychiatrist services delivered in Vietnam Ho Chi Minh City. Our team of board-certified Psychiatrist specialists is dedicated to offering evidence-based mental health care tailored to the diverse cultural and linguistic needs of patients residing in and visiting Vietnam Ho Chi Minh City. The services outlined below encompass initial assessment, ongoing therapeutic intervention, pharmacological management, and follow-up care, all conducted in compliance with the Ministry of Health regulations of the Socialist Republic of Vietnam.
| No. | Psychiatrist Service Description | Duration / Frequency | Unit Price (VND) | Subtotal (VND) | Notes |
|---|---|---|---|---|---|
| 1 | Initial Psychiatrist Consultation & Comprehensive Psychiatric Assessment | 60 minutes / One-time | 2,500,000 | 2,500,000 | Includes medical history review |
| 2 | Psychiatrist Follow-Up Consultation (Standard) | 45 minutes / Bi-weekly x 8 sessions | 1,800,000 | 14,400,000 | Progress monitoring & plan adjustment |
| 3 | Psychiatrist-Covered Cognitive Behavioral Therapy (CBT) Sessions | 50 minutes / Weekly x 12 sessions | 2,200,000 | 26,400,000 | Conducted by licensed Psychiatrist or supervised therapist |
| 4 | Psychiatric Medication Management & Prescription Renewal | 30 minutes / Monthly x 6 months | 1,200,000 | 7,200,000 | Includes drug interaction screening |
| 5 | Psychological & Neuropsychological Testing (Administered under Psychiatrist supervision) | 90 minutes / One-time | 3,500,000 | 3,500,000 | MMPI, WAIS, or equivalent instruments |
| 6 | Urgent / Emergency Psychiatrist Visit (After-Hours) | As needed / Up to 2 visits | 3,000,000 | 6,000,000 | Available 24/7 in Vietnam Ho Chi Minh City |
| 7 | Home Visit by Psychiatrist (Within District 1, 3, or Binh Thanh) | 60 minutes / One-time | 4,000,000 | 4,000,000 | Travel within Vietnam Ho Chi Minh City limits |
| 8 | Family Psychoeducation Session (Led by treating Psychiatrist) | 75 minutes / One-time | 2,800,000 | 2,800,000 | Up to 4 family members included |
| 9 | Annual Psychiatrist Comprehensive Review & Treatment Plan Update | 90 minutes / One-time | 3,200,000 | 3,200,000 | Includes updated diagnostic coding |
| 10 | Administrative & Record-Keeping Fee (Medical file, digital records, insurance documentation) | Per treatment cycle | 500,000 | 500,000 | One-time charge |
| TOTAL ESTIMATED COST (VND) | 70,500,000 | ≈ USD 2,750 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing for Psychiatrist services in Vietnam Ho Chi Minh City may be subject to revision based on prevailing market conditions and regulatory updates.
- All Psychiatrist consultations and therapeutic sessions are conducted at our facility located in District 1, Vietnam Ho Chi Minh City, unless a home visit has been explicitly scheduled and approved in writing.
- A deposit of 30% of the total Quotation Estimate amount is required to secure the initial Psychiatrist appointment. The remaining balance is payable upon completion of the first treatment cycle.
- Cancellations of Psychiatrist appointments must be made at least 24 hours in advance. Late cancellations or no-shows will incur a fee of 50% of the scheduled session rate.
- All medical records, diagnostic reports, and treatment plans generated during the course of Psychiatrist care are the confidential property of the client and are stored in accordance with Vietnam's Personal Data Protection Law (2023) and the Ministry of Health's medical record retention regulations.
- This Quotation Estimate does not include the cost of prescribed psychiatric medications, laboratory tests (blood work, thyroid panels, toxicology screens), or imaging studies (MRI, CT), which will be itemized separately upon the Psychiatrist's recommendation.
- Payment may be made in Vietnamese Dong (VND) via bank transfer, cash, or major credit card. International clients in Vietnam Ho Chi Minh City may also settle in USD at the prevailing Vietcombank exchange rate on the date of payment.
- Our Psychiatrist team operates under strict ethical guidelines. In the event of a clinical emergency, the treating Psychiatrist reserves the right to refer the client to the nearest emergency psychiatric ward in Vietnam Ho Chi Minh City (e.g., Ho Chi Minh City Psychiatric Hospital, District 8) at no additional administrative cost.
- This Quotation Estimate is non-transferable and is issued exclusively to the named client. Any change in the scope of Psychiatrist services requires a written amendment signed by both parties.
- By accepting this Quotation Estimate, the client acknowledges that Psychiatrist services are professional medical interventions and that outcomes, while expected to be positive, cannot be absolutely guaranteed due to the individual nature of mental health conditions.
By signing below, the client confirms that they have read, understood, and agree to all terms set forth in this Quotation Estimate for Psychiatrist services in Vietnam Ho Chi Minh City. The treating Psychiatrist will be assigned within 48 hours of acceptance.
Client Signature
Name: _________________________
Date: _________________________
Authorized Representative – Saigon Mind Wellness Center
Name: Dr. Nguyen Thi Lan, MD (Psychiatrist)
Date: _________________________
Seal / Stamp
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