Quotation Estimate Psychologist in Belgium Brussels –Free Word Template Download with AI

Quotation Estimate

Quotation Details

Quotation No: QTE-2025-BRU-0487

Date of Issue: 14 June 2025

Valid Until: 14 September 2025 (90 days)

Currency: EUR (€)

Country of Service: Belgium – Brussels Capital-Region

Client Information

Name: [Client Full Name]

Address: [Street, Number], [Postal Code] Brussels, Belgium

National Register No (RNI): [XXXX.XXXX.XXX-X]

Health Insurance: [Mutualité / Mutualiteit Name]

Contact: [Phone / Email]

This Quotation Estimate is issued by the Brussels Psychological Care Centre to provide a transparent, itemised financial overview of the professional services to be rendered by a licensed Psychologist operating within the Brussels Capital-Region of Belgium. This document serves as a formal cost projection and does not constitute a binding contract until accepted in writing by the client. All pricing reflects the current Belgian regulatory framework governing the practice of psychology, including the Royal Decree of 22 December 2011 on the use of the title "Psychologist" and the applicable fee schedules of the Belgian Mutual Insurance Funds (RIZIV/INAMI).

The Psychologist referenced in this Quotation Estimate is a fully registered and certified professional holding a recognised Master's degree in Psychology from a Belgian or EU-accredited university, as required by Belgian law. The Psychologist is registered with the Belgian Professional Order and maintains full professional liability insurance in accordance with the regulations of the Brussels-Capital Region. The services outlined below are to be delivered at our Brussels office or, where applicable, via secure telehealth platforms compliant with Belgian data protection legislation (GDPR and the Belgian Privacy Act of 30 July 2018).

Ref	Service Description	Duration / Frequency	Unit Price (EUR)	Quantity	Subtotal (EUR)
01	Initial Psychologist Consultation & Comprehensive Psychological Assessment (intake interview, history review, standardised testing)	120 minutes – One-time	€ 180.00	1	€ 180.00
02	Individual Psychotherapy Session (cognitive-behavioural, psychodynamic, or integrative approach as determined by the Psychologist)	50 minutes – Weekly	€ 110.00	12	€ 1,320.00
03	Psychological Testing & Diagnostic Battery (e.g., WAIS-IV, MMPI-2, BDI-II, administered and interpreted by the Psychologist)	90 minutes – One-time	€ 250.00	1	€ 250.00
04	Written Psychological Report & Clinical Summary (for referral to a Belgian psychiatrist, employer, or court, as applicable)	Per report	€ 150.00	1	€ 150.00
05	Follow-up Review Session with the Psychologist (progress evaluation and treatment plan adjustment)	45 minutes – Monthly	€ 95.00	3	€ 285.00
06	Urgent / Out-of-Hours Psychologist Consultation (Brussels, subject to availability)	30 minutes – As needed	€ 130.00	1	€ 130.00
TOTAL ESTIMATED COST (before applicable Belgian VAT where applicable)					€ 2,315.00

Note on Belgian VAT: Psychological and psychotherapeutic services provided by a registered Psychologist in Belgium are generally exempt from Value Added Tax (VAT) under Article 44, §1, 2° of the Belgian VAT Code (Code TVA / Wet BTW), provided the services are rendered in the interest of the patient's health. No VAT is therefore applied to the amounts listed above. Should any ancillary administrative services be added, a standard 21% Belgian VAT rate will apply to those specific line items.

Clients residing in Brussels, Belgium, who hold a valid Belgian health insurance card (carte d'identité / identiteitskaart) and are affiliated with a recognised Mutualité (e.g., Solidaris, CM, Solidaris, or a private mutualité), may be eligible for partial reimbursement of the Psychologist's fees through the RIZIV/INAMI. The standard reimbursement rate for a Psychologist session in Belgium is approximately € 25.00 to € 35.00 per 50-minute session, subject to the specific tariff grid in force at the time of treatment. The client is responsible for the remaining co-payment. This Quotation Estimate does not guarantee a specific reimbursement amount, as this is determined solely by the client's Mutualité and the applicable Belgian federal tariff.

Validity: This Quotation Estimate is valid for a period of ninety (90) calendar days from the date of issue. After this period, the Psychologist reserves the right to revise the pricing in accordance with any changes in the Belgian fee schedule or operational costs in Brussels.
Acceptance: The client must sign and return a copy of this Quotation Estimate to the Brussels Psychological Care Centre within the validity period to confirm engagement of the Psychologist's services.
Cancellation Policy: Appointments with the Psychologist must be cancelled at least forty-eight (48) hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee as stipulated in this Quotation Estimate.
Confidentiality: All information exchanged between the client and the Psychologist is protected under Belgian professional secrecy (art. 458 of the Belgian Penal Code) and the GDPR. No data will be shared without the client's explicit written consent, except where Belgian law mandates disclosure.
Payment Terms: Payment is due at the time of each session or within fourteen (14) calendar days of the invoice date, whichever is earlier. Accepted payment methods include bank transfer to the Brussels office account, credit card, and cash. A 10% administrative surcharge applies to payments made more than thirty (30) days after the due date.
Scope Limitation: The Psychologist referenced in this Quotation Estimate provides psychological assessment, counselling, and psychotherapy. The Psychologist does not prescribe medication. If a psychiatric referral is deemed necessary, the Psychologist will coordinate with a licensed Belgian psychiatrist, and any associated costs will be quoted separately.
Governing Law: This Quotation Estimate and any resulting service agreement are governed by the laws of the Kingdom of Belgium. Any disputes shall be submitted to the competent courts of Brussels, Belgium.
Complaints: Clients may lodge a formal complaint with the Brussels Psychological Care Centre or, alternatively, with the Belgian Federal Agency for the Safety of the Food Chain (AFSCA) or the relevant Mutualité's ethics committee.

By signing below, the client acknowledges receipt of this Quotation Estimate for the Psychologist's services in Brussels, Belgium, and agrees to the terms and conditions set forth herein. This signature does not obligate the client to commence treatment immediately but confirms the acceptance of the quoted rates and conditions for the validity period stated above.

For the Brussels Psychological Care Centre
[Name of Supervising Psychologist]
Licensed Psychologist – Belgium
Date: _______________ Client
[Full Name]
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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