Quotation Estimate Speech Therapist in United States Houston –Free Word Template Download with AI
Service Provider
Houston Speech & Language Therapy Center
4820 Westheimer Road, Suite 310
Houston, Texas 77056
United States of America
Phone: (713) 555-0142
Email: [email protected]
Texas License No.: ST-2024-88471
Client Information
Client Name: [To Be Completed]
Address: [To Be Completed]
City, State, ZIP: Houston, TX [ZIP]
United States
Phone: [To Be Completed]
Email: [To Be Completed]
Insurance Provider: [To Be Completed]
| Quotation Estimate No.: | QTE-2025-HST-00347 |
| Date of Issue: | June 12, 2025 |
| Valid Until: | July 12, 2025 (30 days) |
| Service Location: | Houston, Texas, United States |
| Prepared By: | Dr. Margaret Ellison, M.S., CCC-SLP |
This Quotation Estimate is issued by Houston Speech & Language Therapy Center to provide a comprehensive, itemized financial projection for the professional Speech Therapist services to be rendered to the client identified above. This document serves as a formal estimate of costs associated with speech-language pathology evaluation, diagnosis, and therapeutic intervention. All pricing reflected in this Quotation Estimate is specific to services delivered within the Houston, Texas metropolitan area in the United States and is subject to the terms and conditions outlined herein.
The following Speech Therapist services have been recommended based on the initial clinical assessment conducted on June 5, 2025, at our Houston, United States facility. The treating Speech Therapist, Dr. Margaret Ellison, holds a Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) issued by the American Speech-Language-Hearing Association (ASHA) and is licensed by the Texas State Board of Examiners of Speech-Language Pathology and Audiology.
| # | Service Description | Frequency | Duration | Unit Rate (USD) | Estimated Total (USD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Speech-Language Evaluation & Diagnostic Report | One-time | 90 minutes | $350.00 | $350.00 |
| 2 | Individual Speech Therapy Sessions (Articulation & Phonology) | 2x per week | 45 min/session | $125.00 | $10,000.00 |
| 3 | Language Comprehension & Expression Therapy | 1x per week | 45 min/session | $125.00 | $5,000.00 |
| 4 | Fluency (Stuttering) Intervention Program | 1x per week | 60 min/session | $150.00 | $6,000.00 |
| 5 | Parent/Caregiver Training & Home Program Guidance | Monthly | 60 min/session | $100.00 | $1,200.00 |
| 6 | Progress Assessment & Treatment Plan Revision | Quarterly | 60 min/session | $200.00 | $800.00 |
| 7 | Therapeutic Materials & Augmentative Communication Aids | As needed | N/A | $250.00 | $250.00 |
| TOTAL ESTIMATED COST (USD) | $23,600.00 | ||||
Based on the clinical findings from the initial evaluation, the treating Speech Therapist projects a minimum treatment duration of twenty (20) weeks, with the possibility of extension depending on the client's progress. This Quotation Estimate covers the first twenty-week treatment cycle. Subsequent cycles will require a revised Quotation Estimate issued by our Houston, United States office. The Speech Therapist will conduct a formal re-evaluation at the conclusion of each cycle to determine whether continued therapy is warranted and to adjust the treatment plan accordingly.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Pricing is subject to change after the expiration date without prior notice.
- Payment is due within fifteen (15) days of the date of each monthly invoice. A late payment surcharge of 1.5% per month will be applied to overdue balances.
- A non-refundable deposit of 20% of the total estimated amount ($4,720.00) is required to secure the client's appointment schedule with the Speech Therapist.
- Accepted payment methods include: check, ACH bank transfer, Visa, Mastercard, and American Express. All payments are processed in United States Dollars (USD).
- Insurance billing: This Quotation Estimate reflects out-of-pocket rates. If the client elects to submit claims to their health insurance provider, the Speech Therapist's office will assist with documentation and prior authorization as required by Texas state regulations and the United States federal healthcare guidelines.
- Cancellation policy: Sessions cancelled with less than 24 hours' notice will be billed at 50% of the session fee. No-shows will be billed at 100% of the session fee.
All Speech Therapist services described in this Quotation Estimate will be delivered in full compliance with the standards established by the American Speech-Language-Hearing Association (ASHA), the Texas State Board of Examiners of Speech-Language Pathology and Audiology, and applicable United States federal regulations including HIPAA (Health Insurance Portability and Accountability Act). The Speech Therapist maintains a minimum of 100 hours of continuing education annually to ensure the highest standard of clinical practice in the Houston, Texas community.
By signing below, the client or authorized guardian acknowledges receipt of this Quotation Estimate for Speech Therapist services in Houston, United States, and agrees to the terms, conditions, and estimated costs outlined in this document. This signature does not constitute a binding contract for the full treatment period but authorizes the initiation of services as described herein.
Client / Authorized Guardian SignaturePrinted Name: _________________________ Date: _______________
Speech Therapist / Authorized RepresentativeDr. Margaret Ellison, M.S., CCC-SLP Date: _______________
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