Quotation Estimate Psychologist in Brazil Brasília –Free Word Template Download with AI
Document Reference: QE-PSY-BSB-2025-0417
Date of Issue: 17 June 2025Valid Until: 17 July 2025
Currency: Brazilian Real (BRL / R$) Issued By: Clínica Psicológica do Planalto
Location: Setor Comercial Sul, Quadra 04, Bloco A
City: Brasília — Distrito Federal, Brazil
CRP Registration: CRP 01/123456
1. Client Information
| Field | Details |
|---|---|
| Client / Organization Name | ____________________________ |
| CNPJ / CPF | ____________________________ |
| Address | Brasília — DF, Brazil |
| Contact Person | ____________________________ |
| Email / Phone | ____________________________ |
2. Scope of Psychologist Services
This Quotation Estimate is issued by Clínica Psicológica do Planalto, a licensed and registered psychology practice operating in the Federal District of Brasília, Brazil, to formally present the cost structure for professional Psychologist services. The Psychologist engaged under this Quotation Estimate holds a valid registration with the Conselho Regional de Psicologia (CRP) of the Distrito Federal and is fully qualified to deliver clinical, organizational, and preventive psychological care in accordance with Brazilian federal and state regulations governing the practice of psychology.
The services outlined in this Quotation Estimate are designed to meet the specific mental health and well-being needs of the client within the Brasília metropolitan area. All sessions and interventions will be conducted in Portuguese, the official language of Brazil, and will adhere to the ethical code established by the Conselho Federal de Psicologia (CFP). The Psychologist will provide individualized care plans, progress documentation, and periodic reports as specified below.
3. Itemized Services and Pricing
| Item | Description of Psychologist Service | Frequency | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 3.1 | Initial Psychologist Assessment & Intake Session (comprehensive evaluation, anamnesis, and diagnostic formulation) | One-time | R$ 450,00 | R$ 450,00 |
| 3.2 | Individual Psychotherapy Session (50-minute session with licensed Psychologist in Brasília) | Weekly × 12 | R$ 350,00 | R$ 4,200,00 |
| 3.3 | Psychological Evaluation Report (written clinical report for legal, corporate, or medical purposes, issued in Brasília) | One-time | R$ 800,00 | R$ 800,00 |
| 3.4 | Organizational Psychology Consultation (workplace mental health assessment for Brasília-based company) | 2 sessions | R$ 1,200,00 | R$ 2,400,00 |
| 3.5 | Follow-up and Crisis Intervention (emergency Psychologist availability within Brasília, 24/7) | As needed (est. 2) | R$ 500,00 | R$ 1,000,00 |
| 3.6 | Administrative and Record-Keeping (confidential file management, CFP compliance documentation) | Monthly × 3 | R$ 150,00 | R$ 450,00 |
| TOTAL ESTIMATED COST | R$ 9,300,00 | |||
4. Payment Terms and Conditions
All amounts stated in this Quotation Estimate are denominated in Brazilian Reais (BRL) and are subject to the applicable tax regulations of the Distrito Federal, Brazil. Payment may be made via bank transfer (TED/PIX) to the account of Clínica Psicológica do Planalto, or by corporate invoice (nota fiscal) issued in accordance with Brazilian tax law. A 50% deposit is required upon acceptance of this Quotation Estimate to secure the Psychologist's schedule in Brasília. The remaining balance shall be settled in three equal monthly installments over the treatment period.
This Quotation Estimate remains valid for thirty (30) calendar days from the date of issue. After this period, pricing may be adjusted to reflect changes in the Psychologist's professional fees, operational costs in Brasília, or regulatory updates from the Conselho Federal de Psicologia.
5. Professional and Legal Disclaimers
Important: This Quotation Estimate does not constitute a binding contract until formally signed by both parties. The Psychologist services described herein are subject to the ethical and legal framework of Brazilian psychology practice (Law No. 4,119/1962 and CFP resolutions). All client data processed in Brasília is protected under the Brazilian General Data Protection Law (LGPD — Lei Geral de Proteção de Dados, Law No. 13,709/2018). The Psychologist reserves the right to refer the client to a psychiatrist or other specialist if clinical judgment deems it necessary, and such referrals are not included in the pricing of this Quotation Estimate.
6. Acceptance and Signatures
By signing below, the client acknowledges receipt of this Quotation Estimate for Psychologist services in Brasília, Brazil, and agrees to the terms, conditions, and pricing outlined herein. The Psychologist and the Clínica Psicológica do Planalto confirm their commitment to delivering the services described with the highest standards of professional ethics and clinical excellence.
Client / Authorized RepresentativeName: ____________________________
Date: ____________________________ Psychologist / Clínica Psicológica do Planalto
Name: ____________________________
CRP: ____________________________
Date: ____________________________ ⬇️ Download as DOCX Edit online as DOCX
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