Quotation Estimate Psychologist in Brazil Rio de Janeiro –Free Word Template Download with AI
Rua das Acácias, 1250 – Leblon, Rio de Janeiro, RJ – CEP 22430-000
CNPJ: 12.345.678/0001-90 | CRP 05/48.721
Phone: +55 (21) 3456-7890 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QE-2025-00847
Date Issued: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Location: Brazil Rio de Janeiro
Client Information
Client Name: [Client Full Name]
Document (CPF/CNPJ): [Number]
Address: [Client Address, Rio de Janeiro, RJ]
Contact: [Phone / Email]
This Quotation Estimate is issued by Clínica Psicológica Rio Serenidade, a licensed and regulated psychological practice operating in the city of Rio de Janeiro, Brazil. The purpose of this document is to provide the client with a comprehensive, transparent, and detailed breakdown of all professional services to be rendered by our Psychologist team. All pricing, session structures, and terms outlined herein are specific to the practice of psychology as regulated by the Conselho Regional de Psicologia (CRP) 5ª Região – Rio de Janeiro, and comply with all applicable Brazilian federal and state legislation governing mental health services.
Scope of Services – Psychologist ProfessionalThe Psychologist assigned to this engagement holds a full license (CRP 05/48.721) and specializes in clinical psychology, cognitive-behavioral therapy, and psychosocial assessment. The services described in this Quotation Estimate are tailored to the individual needs of the client and may include, but are not limited to, the following professional activities conducted within the clinic premises located in the Leblon district of Rio de Janeiro, Brazil, or via secure telehealth platforms as permitted by Brazilian health regulations.
Itemized Quotation Estimate| # | Service Description | Duration | Frequency | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|---|
| 01 | Initial Psychological Assessment & Intake Session (comprehensive evaluation, history review, and treatment plan formulation) | 90 minutes | One-time | R$ 450,00 | R$ 450,00 |
| 02 | Individual Psychotherapy Session (Cognitive-Behavioral Therapy – CBT modality) | 50 minutes | Weekly (12 sessions) | R$ 350,00 | R$ 4.200,00 |
| 03 | Psychological Evaluation Report (written diagnostic report for medical, legal, or occupational purposes) | — | One-time | R$ 800,00 | R$ 800,00 |
| 04 | Emergency / Crisis Intervention Session (available within 48 hours, subject to Psychologist availability) | 60 minutes | As needed (max 2) | R$ 400,00 | R$ 800,00 |
| 05 | Telehealth Psychotherapy Session (conducted via encrypted video platform, compliant with CRP telepsychology guidelines) | 50 minutes | Bi-weekly (6 sessions) | R$ 300,00 | R$ 1.800,00 |
| 06 | Family / Couples Therapy Session (Psychologist facilitates structured dialogue and conflict resolution) | 75 minutes | Monthly (4 sessions) | R$ 500,00 | R$ 2.000,00 |
| 07 | Progress Review & Treatment Plan Adjustment (mid-course and final review with the Psychologist) | 45 minutes | Twice (mid & final) | R$ 250,00 | R$ 500,00 |
| 08 | Administrative & Record-Keeping Fee (file management, confidentiality compliance, and documentation per Brazilian LGPD) | — | One-time | R$ 150,00 | R$ 150,00 |
| TOTAL ESTIMATED COST (BRL) | R$ 10.700,00 | ||||
1. This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issuance. After the expiration date, all prices and availability terms are subject to revision by the Psychologist and the clinic management.
2. All services are to be performed by a licensed Psychologist registered with the Conselho Regional de Psicologia (CRP) 5ª Região – Rio de Janeiro, Brazil. The Psychologist reserves the right to refer the client to a specialist colleague if the clinical presentation requires a different area of expertise.
3. Payment terms: 50% of the total Quotation Estimate amount is due upon acceptance of this document, and the remaining 50% is to be settled in equal monthly installments over the course of the treatment plan. Accepted payment methods include bank transfer (TED/PIX), credit card (up to 3 installments), and cash at the clinic office in Rio de Janeiro.
4. Cancellation policy: Sessions cancelled with less than 24 hours' prior notice will be charged at 50% of the session fee. No-shows will be charged in full. This policy applies to all in-person and telehealth sessions conducted by the Psychologist.
5. Confidentiality: All information shared during sessions is protected under the Code of Ethics of the Brazilian Psychologist and the General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Law No. 13.709/2018). Records are stored securely at the clinic in Rio de Janeiro and are never disclosed without written client consent, except where mandated by law.
6. This Quotation Estimate does not constitute a guarantee of specific therapeutic outcomes. The Psychologist commits to providing evidence-based, ethical, and professional care in accordance with the standards established by the CRP and the Brazilian Ministry of Health.
7. Any additional services not listed in this Quotation Estimate (e.g., extended therapy beyond the planned sessions, additional psychological evaluations, or group therapy) will be subject to a separate written Quotation Estimate issued by the clinic.
8. This document is governed by the laws of the Federative Republic of Brazil, and any disputes arising from this Quotation Estimate shall be resolved in the courts of the city of Rio de Janeiro, State of Rio de Janeiro, Brazil.
Acceptance and AuthorizationBy signing below, the client acknowledges that they have read, understood, and accepted all terms, conditions, and pricing outlined in this Quotation Estimate. The client further confirms that the Psychologist has explained the scope of services, the expected duration of treatment, and the client's rights regarding confidentiality and data protection in Brazil.
Client SignatureName: ______________________________
CPF: ______________________________
Date: ______________________________ Psychologist / Clinic Representative
Name: Dr(a). ______________________________
CRP 05/48.721
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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