Quotation Estimate Speech Therapist in United States Miami –Free Word Template Download with AI
Professional Speech Therapist Services
Serving the Greater Miami Area, United States
Document No. QTE-2025-04871Provider Information
ClearVoice Speech Therapy Center
1200 Brickell Avenue, Suite 450
Miami, Florida 33131, United States
Phone: (305) 555-0142
Email: [email protected]
FL License No. SLP-2019-88432
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Miami, FL
Phone: [Client Phone Number]
Email: [Client Email]
Insurance Provider: [Insurance Company]
Policy Number: [Policy Number]
Quotation Details
Date of Issue: June 15, 2025
Valid Until: July 15, 2025
Prepared By: Dr. Maria Santos, M.S., CCC-SLP
Service Location: Miami, United States
Referral & Authorization
Referring Physician: Dr. James Whitfield, M.D.
Referral Date: June 10, 2025
Insurance Pre-Authorization: Approved
Authorization Ref: AUTH-2025-33921
This Quotation Estimate outlines the comprehensive Speech Therapist services to be provided to the above-named client at our Miami, Florida facility. The Speech Therapist program has been designed following a thorough initial assessment conducted on June 10, 2025, and is tailored to address the specific communication needs identified during the diagnostic evaluation. All services will be delivered in accordance with the standards set forth by the American Speech-Language-Hearing Association (ASHA) and the Florida Department of Health regulations governing licensed Speech Therapist professionals in the United States.
| Item # | Service Description | Frequency | Duration | Unit Rate | Estimated Total |
|---|---|---|---|---|---|
| 01 | Initial Comprehensive Speech Assessment & Diagnostic Evaluation | One-time | 90 minutes | $275.00 | $275.00 |
| 02 | Individual Speech Therapy Sessions (Articulation & Phonology) | 2x per week | 45 min/session | $150.00 | $4,800.00 |
| 03 | Language Comprehension & Expression Therapy | 1x per week | 45 min/session | $150.00 | $2,400.00 |
| 04 | Fluency & Stuttering Intervention Program | 1x per week | 45 min/session | $150.00 | $2,400.00 |
| 05 | Parent/Caregiver Training & Home Program Guidance | 1x per month | 60 min/session | $125.00 | $500.00 |
| 06 | Progress Evaluation & Treatment Plan Revision (Monthly) | 1x per month | 30 min/session | $95.00 | $380.00 |
| 07 | Therapeutic Materials, Workbooks & Digital Resources | One-time | N/A | $185.00 | $185.00 |
| 08 | Final Discharge Assessment & Comprehensive Report | One-time | 60 minutes | $225.00 | $225.00 |
| TOTAL ESTIMATED COST (12-Week Program) | $11,165.00 | ||||
This Quotation Estimate reflects the full fee schedule for Speech Therapist services in Miami, United States. Based on the client's insurance coverage with the listed provider, an estimated reimbursement of $8,932.00 is anticipated, leaving a client responsibility of approximately $2,233.00. The client's deductible of $1,500.00 (with $450.00 remaining) will be applied first. All billing will be processed in accordance with CPT codes 92507, 92524, 92526, and 92529 as applicable. Payment is due within 30 days of the invoice date. We accept all major credit cards, HSA/FSA cards, and direct insurance billing. A 1.5% monthly late fee will be applied to balances exceeding 30 days past due.
The recommended Speech Therapist treatment program spans twelve (12) weeks, commencing on July 1, 2025, and concluding on September 26, 2025, subject to the client's progress and the Speech Therapist's clinical judgment. Sessions will be scheduled at the ClearVoice Speech Therapy Center located in downtown Miami, United States. The client may reschedule appointments with a minimum of 24 hours' notice. Cancellations made within 24 hours of the scheduled session will be subject to a 50% session fee. The Speech Therapist will conduct a mid-program review at the six-week mark to determine whether the treatment plan requires modification or extension.
Terms & Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After the expiration date, pricing may be subject to revision based on current market rates for Speech Therapist services in the Miami, United States area.
- All services described herein will be performed by a licensed, certified Speech Therapist (CCC-SLP) in compliance with Florida state regulations and ASHA professional standards.
- The total estimated cost is based on the projected twelve-week program. If the Speech Therapist determines that additional sessions are clinically necessary, a supplemental Quotation Estimate will be issued prior to any additional services being rendered.
- Client confidentiality is maintained in full accordance with HIPAA regulations. All records, progress notes, and assessment data will be stored securely at our Miami, Florida facility.
- This Quotation Estimate does not constitute a guarantee of specific therapeutic outcomes. The Speech Therapist will use best clinical practices to maximize the client's communication progress.
- By signing below, the client acknowledges receipt and understanding of this Quotation Estimate and authorizes ClearVoice Speech Therapy Center to proceed with the outlined Speech Therapist services in Miami, United States.
- Any disputes arising from this Quotation Estimate shall be resolved under the laws of the State of Florida, United States, with jurisdiction in Miami-Dade County.
Date: ______________________ Dr. Maria Santos, M.S., CCC-SLP
Lead Speech Therapist – ClearVoice Miami
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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