Quotation Estimate Psychologist in Canada Vancouver –Free Word Template Download with AI
Registered Psychologist Practice | BC College of Psychologists
1200 West Georgia Street, Suite 450, Vancouver, British Columbia, V6E 4E2, Canada
Phone: (604) 555-0187 | Email: [email protected]
BC Reg. No. BC-2024-004821 | GST/HST No. 123456789RT0001
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-00347
Date Issued: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Prepared By: Dr. Sarah Chen, M.A., Psychologist
Service Location: Vancouver, British Columbia, Canada
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Vancouver, BC, Canada
Phone: [Client Phone Number]
Email: [Client Email Address]
Referral Source: [Referring Physician / Self-Referral]
Dear Valued Client,
Thank you for considering the professional psychological services offered by Coastal Mind Wellness Centre in Vancouver, Canada. This Quotation Estimate has been prepared to provide you with a comprehensive and transparent breakdown of the fees associated with the psychological assessment, therapy, and ongoing support services that our licensed Psychologist will deliver on your behalf. All services described herein are conducted in full compliance with the regulations set forth by the British Columbia College of Psychologists and the broader standards of the Canadian Psychological Association.
Please review this Quotation Estimate carefully. It outlines the scope of services, the estimated duration of treatment, and the associated professional fees. All pricing is quoted in Canadian Dollars (CAD) and reflects the current market rates for psychological services in the Vancouver, Canada metropolitan area as of the date of issuance.
Scope of Psychological ServicesThe following services have been recommended based on the initial consultation and clinical assessment conducted by our Psychologist in Vancouver, Canada. The treatment plan is designed to address the client's specific mental health needs through evidence-based therapeutic modalities, including Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), and psychodynamic approaches as clinically indicated.
| # | Service Description | Duration / Frequency | Unit (CAD) | Qty | Subtotal (CAD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Psychological Assessment (including WAIS-IV, MMPI-2, and clinical interview) | 3 hours (one-time) | $1,200.00 | 1 | $1,200.00 |
| 2 | Individual Psychotherapy Session (CBT / DBT) – 50 minutes per session | 50 min / weekly | $185.00 | 16 | $2,960.00 |
| 3 | Psychological Report and Written Clinical Summary (for employer, court, or insurance purposes) | One-time deliverable | $450.00 | 1 | $450.00 |
| 4 | Telehealth / Video Consultation Session (for clients unable to attend in person in Vancouver) | 50 min / bi-weekly | $165.00 | 8 | $1,320.00 |
| 5 | Crisis Intervention and Emergency Psychologist Consultation (after-hours, up to 2 hours) | As needed (est. 2 occurrences) | $350.00 | 2 | $700.00 |
| 6 | Progress Review and Treatment Plan Adjustment Session (quarterly) | 60 min / quarterly | $200.00 | 2 | $400.00 |
| 7 | Administrative and Record-Keeping Fees (file management, insurance billing, documentation) | Monthly | $25.00 | 4 | $100.00 |
| TOTAL ESTIMATED FEE (CAD) | $7,130.00 | ||||
- Payment Schedule: A 25% deposit of the total Quotation Estimate amount (CAD $1,782.50) is due upon acceptance of this document to secure the client's appointment schedule with the Psychologist. The remaining balance shall be invoiced monthly in arrears.
- Accepted Payment Methods: Interac e-Transfer, Visa, Mastercard, American Express, and certified cheques payable to Coastal Mind Wellness Centre. All payments are processed in Canadian Dollars (CAD).
- Insurance and Billing: Our Psychologist in Vancouver, Canada is a registered provider with major Canadian health insurance plans including Medavie, Sun Life, Manulife, and Canada Life. We will submit claims directly on the client's behalf where applicable. The client is responsible for any deductibles, co-pays, or amounts exceeding plan coverage.
- Cancellation Policy: Sessions cancelled with less than 24 hours' notice will be subject to a 50% fee of the scheduled session rate. No-shows will be billed at 100% of the session fee.
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. Fees are subject to adjustment based on changes in the BC College of Psychologists fee guidelines or the client's evolving clinical needs.
- Confidentiality: All clinical records, assessment data, and session notes are maintained in strict accordance with the Personal Information Protection Act (PIPA) of British Columbia and the Canadian Health Information Protection standards. No information will be disclosed without written client consent, except where required by law.
- Scope Limitations: This Quotation Estimate covers the services explicitly listed above. Any additional assessments, extended therapy beyond the estimated 16 sessions, or specialized interventions (e.g., neuropsychological testing, group therapy) will be subject to a separate written Quotation Estimate prior to commencement.
- Dispute Resolution: Any disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the Province of British Columbia and the jurisdiction of the courts of Vancouver, Canada.
Please be advised that the estimated timeline for the full course of treatment outlined in this Quotation Estimate is approximately four (4) months, assuming weekly attendance and no extended interruptions. The Psychologist will conduct a formal progress evaluation at the end of the 16th individual therapy session to determine whether additional sessions, referrals, or a modified treatment plan are necessary. Any such modifications will be communicated in writing and will not alter the terms of this Quotation Estimate unless a formal amendment is executed by both parties.
Coastal Mind Wellness Centre is committed to providing the highest standard of psychological care in Vancouver, Canada. Our Psychologist holds a Doctorate in Clinical Psychology, is a full member of the Canadian Psychological Association, and maintains active registration with the BC College of Psychologists. All therapeutic approaches employed are grounded in peer-reviewed, evidence-based practice.
Client Acknowledgement and Acceptance
By signing below, the client acknowledges that they have received, read, and understood this Quotation Estimate for psychological services in Vancouver, Canada. The client agrees to the terms, conditions, and fee structure outlined in this document and authorizes Coastal Mind Wellness Centre to commence the services as described.
Client Signature Printed Name Date Dr. Sarah Chen, Psychologist (Authorized Signatory) Coastal Mind Wellness Centre, Vancouver, BC, Canada Date
STATUS: PENDING CLIENT ACCEPTANCE ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT