Quotation Estimate Psychologist in Netherlands Amsterdam –Free Word Template Download with AI
Prinsengracht 452, 1016 KE Amsterdam, Netherlands
Phone: +31 (0)20 555 0142 | Email: [email protected]
KvK: 87654321 | BTW: NL861234567B01
Quotation EstimateQuotation Details
Quotation No.: QE-2025-AMST-0847
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Margriet van der Berg, Registered Psychologist
Location: Netherlands Amsterdam
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Amsterdam, Netherlands
Phone: [Client Phone Number]
Email: [Client Email Address]
Insurance Provider: [Insurance Company Name]
Dear [Client Name],
Thank you for contacting the Amsterdam Psychological Care Centre. This Quotation Estimate has been prepared specifically for you following your initial consultation with our Psychologist team in Netherlands Amsterdam. We are pleased to provide you with a detailed and transparent overview of the psychological services we can offer, along with the associated costs. This document serves as a formal Quotation Estimate outlining the scope of treatment, session frequency, and financial commitment required for your ongoing care with our licensed Psychologist.
Based on the initial assessment conducted by our senior Psychologist, Dr. Margriet van der Berg, the following treatment plan has been recommended. All services are delivered in our fully equipped practice located in the heart of Netherlands Amsterdam, ensuring convenient access for clients residing throughout the city and surrounding municipalities including Amstelveen, Haarlem, and Zandvoort.
| Item No. | Description of Service | Frequency | Duration | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychological Assessment by a licensed Psychologist (includes intake interview, standardized testing, and diagnostic evaluation) | One-time | 120 min | € 185.00 | € 185.00 |
| 2 | Individual Psychotherapy Sessions with a registered Psychologist (Cognitive Behavioural Therapy / Psychodynamic Therapy as indicated) | Weekly (12 sessions) | 50 min each | € 120.00 | € 1,440.00 |
| 3 | Progress Review and Treatment Plan Adjustment by the Psychologist | Monthly (3 sessions) | 30 min each | € 75.00 | € 225.00 |
| 4 | Psychological Testing and Standardized Assessment (e.g., MMPI-2, WAIS-IV, BDI-II) administered by the Psychologist | As required (2 administrations) | 90 min each | € 150.00 | € 300.00 |
| 5 | Written Psychological Report and Treatment Summary prepared by the Psychologist for referral or insurance purposes | One-time | — | € 95.00 | € 95.00 |
| 6 | Emergency / Crisis Consultation with the Psychologist (outside scheduled hours, Netherlands Amsterdam practice) | As needed (up to 2) | 30 min each | € 85.00 | € 170.00 |
| Subtotal | € 2,415.00 | ||||
| VAT (21% – Netherlands Standard Rate) | € 507.15 | ||||
| Grand Total (Quotation Estimate) | € 2,922.15 | ||||
Please note that in the Netherlands, psychological care provided by a registered Psychologist (inschrijving BIG-register) is partially or fully covered under the supplementary mental health insurance (zorgverzekering) offered by Dutch insurers. This Quotation Estimate reflects the standard fee schedule of our practice in Netherlands Amsterdam. If your insurance policy includes a general mental health supplement (algemene zorg), the Psychologist sessions listed above may be reimbursed at a rate determined by your insurer. We recommend verifying your coverage with your insurance provider prior to commencing treatment. Our practice in Netherlands Amsterdam is registered with all major Dutch health insurers including Zilveren Kruis, VGZ, Menzis, CZ, and OHRA.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on updated fee schedules in Netherlands Amsterdam.
- All services described in this Quotation Estimate will be delivered by a qualified, BIG-registered Psychologist or under the direct supervision of one. No services will be delegated to unlicensed personnel.
- Payment is due within fourteen (14) days of the invoice date. Invoices are issued per session or per monthly block, as agreed upon in the treatment plan. This Quotation Estimate represents the projected total cost for the initial twelve-week treatment period.
- Cancellations must be made at least forty-eight (48) hours in advance. Sessions cancelled with less than forty-eight hours' notice will be billed at the full rate as stated in this Quotation Estimate.
- The Psychologist reserves the right to adjust the treatment plan, session frequency, or duration based on clinical progress. Any such adjustments will be communicated in writing and a revised Quotation Estimate will be provided if additional costs are incurred.
- All client data and session records are handled in strict accordance with the Dutch General Data Protection Regulation (AVG/GDPR) and the professional code of conduct of the Dutch Society of Psychologists (NVP). Confidentiality is maintained at all times within our Netherlands Amsterdam practice.
- This Quotation Estimate does not constitute a binding contract until signed and returned by the client. Upon acceptance, a formal treatment agreement will be executed between the client and the Amsterdam Psychological Care Centre.
- Any disputes arising from the services described in this Quotation Estimate shall be resolved in accordance with Dutch law and under the jurisdiction of the courts in Amsterdam, Netherlands.
By signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for psychological services to be provided by a licensed Psychologist at the Amsterdam Psychological Care Centre, Netherlands Amsterdam. The client agrees to the terms and conditions outlined above and authorizes the practice to commence the described treatment plan.
Client Signature:
_______________________________
Name: [Client Full Name]
Date: ___________________
Psychologist / Practice Representative:
_______________________________
Dr. Margriet van der Berg, Psychologist
Date: ___________________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT