Quotation Estimate Psychologist in New Zealand Wellington –Free Word Template Download with AI

Quotation Estimate

Quotation Details

Quotation Estimate No.: QTE-2025-WLG-0417

Date of Issue: 12 June 2025

Valid Until: 12 July 2025 (30 days)

Prepared By: Dr. Sarah Mitchell, Registered Psychologist

Location: New Zealand Wellington

Client / Recipient

Client Name: [Client Full Name]

Address: [Client Address], Wellington, New Zealand

Phone: [Client Phone Number]

Email: [Client Email Address]

Referral Source: [GP / Self-Referral / Employer]

Dear [Client Name],

Thank you for contacting Harbourview Psychological Services regarding professional psychological support in New Zealand Wellington. This Quotation Estimate has been prepared to outline the scope of services, associated fees, and terms under which our Psychologist will provide assessment, therapy, and ongoing support tailored to your individual needs. Please review this document carefully before proceeding with engagement.

The following Quotation Estimate covers a comprehensive package of psychological services to be delivered by a fully registered Psychologist operating in New Zealand Wellington. All services are conducted in accordance with the New Zealand Psychologists Board Code of Ethics and professional standards. The Psychologist assigned to your case will hold a minimum of a Master's degree in Psychology and current registration with the NZ Psychologists Board.

Item No.	Description of Service	Duration / Frequency	Unit Rate (NZD)	Subtotal (NZD)
1	Initial Psychological Assessment & Intake Session – Comprehensive evaluation conducted by the Psychologist to establish baseline mental health status, identify presenting concerns, and develop a personalised treatment plan.	1 session (90 minutes)	$285.00	$285.00
2	Individual Psychotherapy Sessions – Ongoing one-on-one therapeutic sessions with the Psychologist using evidence-based modalities (CBT, EMDR, or integrative approaches as clinically indicated).	12 sessions (50 minutes each, weekly)	$220.00	$2,640.00
3	Psychological Testing & Assessment – Administration and interpretation of standardised psychometric instruments (e.g., WAIS-IV, BDI-II, MMPI-2) to support diagnosis and treatment planning.	1 session (120 minutes)	$350.00	$350.00
4	Written Psychological Report – A detailed clinical report prepared by the Psychologist summarising findings, diagnosis, and recommendations, suitable for submission to medical practitioners, employers, or legal authorities in New Zealand Wellington.	1 report (within 10 business days)	$450.00	$450.00
5	Family / Couples Session – Joint therapeutic session involving the client and up to two additional participants, facilitated by the Psychologist to address relational dynamics and support systems.	2 sessions (75 minutes each)	$265.00	$530.00
6	Progress Review & Treatment Plan Adjustment – Mid-course review session where the Psychologist reassesses progress, adjusts therapeutic strategies, and updates the care plan.	1 session (50 minutes)	$220.00	$220.00
7	After-Hours / Urgent Consultation Allowance – Provision for up to two urgent telephone or video consultations outside standard business hours, as may be required during the treatment period in New Zealand Wellington.	Up to 2 calls (20 minutes each)	$150.00	$300.00
TOTAL ESTIMATED COST (NZD, inclusive of GST)				$4,775.00

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Should the client wish to proceed after the expiry date, the Psychologist reserves the right to reissue the estimate with updated rates.
Payment is due within fourteen (14) days of the date of each invoice. Invoices will be issued on a monthly basis or per session, at the client's preference, as agreed upon at the initial intake.
A deposit of 20% of the total Quotation Estimate amount (NZD $955.00) is required to secure the client's place in the Psychologist's caseload and to confirm the treatment schedule.
Accepted payment methods include bank transfer (EFT), credit/debit card, and direct debit. All fees are quoted in New Zealand Dollars (NZD) and include Goods and Services Tax (GST) at the current rate of 15%.
Should the client require services beyond the scope outlined in this Quotation Estimate, the Psychologist will provide a supplementary written estimate prior to commencing any additional work.
Cancellations made less than 24 hours before a scheduled session will incur a fee of 50% of the session rate. No-shows will be charged the full session fee.

All services described in this Quotation Estimate will be delivered by a registered Psychologist in compliance with the Health and Disability Services Commissioner Act 1993 and the New Zealand Psychologists Board Act 2000.
Confidentiality is maintained in accordance with the New Zealand Privacy Act 2020. Client records are stored securely at the New Zealand Wellington office and are accessible only to the treating Psychologist and, where legally required, to authorised third parties.
The Psychologist reserves the right to refer the client to another mental health professional in New Zealand Wellington if the presenting issues fall outside the scope of psychological practice or if a more specialised service is clinically indicated.
This Quotation Estimate does not constitute a guarantee of specific therapeutic outcomes. The Psychologist will exercise professional judgement in determining the most appropriate course of treatment.
In the event of a dispute, both parties agree to first attempt resolution through mediation. If unresolved, the matter will be referred to the Disputes Tribunal in New Zealand Wellington.
This Quotation Estimate is non-transferable and is issued specifically for the named client. Any change in client details requires a revised estimate from the Psychologist.

By signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for psychological services provided by a registered Psychologist in New Zealand Wellington. The client confirms that they have read, understood, and agree to all terms, conditions, and payment arrangements outlined in this document.

Client Signature: ___________________________

Print Name: ___________________________

Date: ___________________________

Psychologist Signature: ___________________________

Print Name: Dr. Sarah Mitchell, M.Psych, Psych. (NZ)

Date: ___________________________

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