Quotation Estimate Psychologist in South Africa Cape Town –Free Word Template Download with AI

Quotation Estimate No: QTE-2025-0847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 Client Name: [Client / Organisation Name]
Client Address: [Street Address, Cape Town, South Africa]
Client Contact: [Phone / Email] 1. Introduction and Scope of Services

This Quotation Estimate is issued by Cape Town Psychological Services (Pty) Ltd, a registered and accredited practice operating in South Africa Cape Town, to provide a comprehensive breakdown of professional Psychologist services as requested by the client. This document serves as a formal Quotation Estimate outlining the scope, duration, and associated costs of the psychological services to be rendered. All services described herein will be delivered in full compliance with the Health Professions Council of South Africa (HPCSA) regulations and the South African National Code of Professional Conduct for Psychologists.

The Psychologist assigned to this engagement is a fully registered General Psychologist with over fifteen (15) years of clinical and organisational experience in the South Africa Cape Town region. The practice is situated in the central business district of Cape Town, providing convenient access for clients across the Western Cape province. This Quotation Estimate reflects current market rates for qualified Psychologist services in South Africa Cape Town as of the date of issue.

2. Itemised Services and Costs

Ref	Description of Service	Duration / Qty	Unit Rate (ZAR)	Amount (ZAR)
2.1	Initial Psychologist Consultation & Intake Assessment – A comprehensive first session conducted by the registered Psychologist to establish client history, present concerns, and determine the appropriate treatment pathway. Includes completion of standardised intake forms and initial risk assessment.	1 session (90 min)	R 1,850.00	R 1,850.00
2.2	Psychological Testing & Assessment – Administration and interpretation of standardised psychometric instruments (e.g., WAIS-IV, MMPI-2, Beck Depression Inventory, Eysenck Personality Questionnaire) by the Psychologist. Includes a detailed written report of findings.	1 package (3 hrs)	R 4,500.00	R 4,500.00
2.3	Individual Psychotherapy Sessions – Ongoing therapeutic sessions (Cognitive Behavioural Therapy / Person-Centred Therapy) conducted by the Psychologist in a private consultation room at the Cape Town practice. Each session is 50 minutes in duration.	12 sessions	R 1,200.00	R 14,400.00
2.4	Progress Review & Treatment Plan Adjustment – Mid-course review session where the Psychologist evaluates therapeutic progress, adjusts the treatment plan as necessary, and provides a written progress summary to the client or referring medical practitioner.	1 session (60 min)	R 1,100.00	R 1,100.00
2.5	Final Discharge Report & Aftercare Recommendations – A comprehensive written report prepared by the Psychologist summarising the full course of treatment, outcomes achieved, and recommendations for ongoing self-management or further support in the South Africa Cape Town community.	1 report	R 950.00	R 950.00
2.6	Telephone / Video Follow-Up Check-In – A 20-minute remote follow-up conducted by the Psychologist within 30 days of the final in-person session to ensure continuity of care.	1 session (20 min)	R 450.00	R 450.00
2.7	Administrative & Record-Keeping Fee – Covers the cost of secure electronic record management, HPCSA compliance documentation, and filing of all clinical records in accordance with South African POPIA legislation.	1 package	R 350.00	R 350.00
Subtotal (excl. VAT):				R 23,600.00
VAT @ 15%:				R 3,540.00
TOTAL AMOUNT DUE (incl. VAT):				R 27,140.00

3. Terms and Conditions of this Quotation Estimate

Validity: This Quotation Estimate is valid for thirty (30) days from the date of issue. Should the client wish to proceed after the validity period, the Psychologist reserves the right to reissue the Quotation Estimate at updated rates prevailing in South Africa Cape Town at that time.
Payment Terms: A deposit of 30% (R 8,142.00) is required upon acceptance of this Quotation Estimate to secure the Psychologist's availability. The remaining balance is payable in two equal instalments: 50% due at the midpoint of the treatment programme and 50% due upon completion of the final session. All payments are to be made via EFT to the practice's designated bank account.
Cancellations: Cancellations of scheduled Psychologist sessions must be communicated at least 24 hours in advance. Late cancellations or no-shows will be charged at 50% of the session fee as outlined in this Quotation Estimate.
Confidentiality: All information shared during the course of treatment will be handled in strict accordance with the Protection of Personal Information Act (POPIA) 2013 and the HPCSA Code of Conduct. The Psychologist will not disclose any client information to third parties without written consent, except where required by South African law.
Scope Limitations: This Quotation Estimate covers the specific services itemised in Section 2. Any additional sessions, emergency consultations, or specialised assessments beyond the stated scope will be quoted separately and require written approval from the client prior to commencement.
Referrals: Should the Psychologist determine during the course of treatment that the client requires services outside the scope of psychological practice (e.g., psychiatric medication management), a referral to a registered medical practitioner in South Africa Cape Town will be made, and such services are not included in this Quotation Estimate.
Dispute Resolution: Any disputes arising from this Quotation Estimate or the services rendered shall be resolved in accordance with the HPCSA dispute resolution process and, where applicable, the jurisdiction of the Cape High Court, South Africa.

4. Acceptance

By signing below, the client acknowledges and accepts the terms, conditions, and costs set out in this Quotation Estimate for the Psychologist services to be provided in South Africa Cape Town. The client confirms that they have read and understood all provisions contained herein.

For and on behalf of the Client:

Name: ______________________________
Signature: ______________________________
Date: ______________________________

For and on behalf of Cape Town Psychological Services (Pty) Ltd:

Name: Dr. N. van der Merwe, Psychologist (HPCSA Reg: 0123456-7)
Signature: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT