Therapy Estimate Template (Free Fillable PDF)
A therapy estimate the client can say yes to: scope in plain words, every line priced, a valid-until date and a deposit rule, all on one page. Same layout as the invoice, so nothing is retyped when the job is approved.
Free, fillable, US Letter. No email, no sign-up.
ESTIMATETherapy estimate template
avoinvoice.com
From
Your business name
Address
Phone · email
Bill to
Client name
Client address
Phone · email
Diagnosis code (superbill)
Client DOB / insurance ID
| Description | Qty × rate | Amount |
|---|
| Session: date of service, CPT code, length, fee | | |
| Session: date of service, CPT code | | |
| Session: date of service, CPT code | | |
| Late cancellation / no-show (not reimbursable) | | |
| Sliding-scale adjustment (negative) | | |
| Payments received (negative) | | |
| | | |
| | | |
SubtotalTaxEstimated total
Fees are due at the time of service; monthly statements show sessions and payments for your records and for out-of-network claims. This document is a superbill when the diagnosis code is completed; submit it to your insurer for reimbursement. Appointments cancelled with less than 24 hours' notice are billed at $75 and are not reimbursable.
What the PDF looks like. Hints in the line table show what a therapist usually prices; type over them.
What to include on a therapy estimate
- Your business name, license and contactThe same header as your invoice, so the two documents match.
- Client and job addressWhere the work will happen.
- Estimate number and date, valid-until date30 days is standard; the date stops old estimates being accepted later.
- Scope in plain wordsWhat is included and, just as important, what is not.
- Line items with quantitiesThe lines a therapist typically bills: session: date of service, cpt code, length, fee, session: date of service, cpt code, session: date of service, cpt code, late cancellation / no-show.
- Allowances and exclusionsMaterials chosen by the client, permits, disposal: say whether they are in or out.
- Deposit and payment scheduleDeposit on acceptance, balance on completion, or progress payments for longer jobs.
- Acceptance lineName, signature, date. A signed estimate is your approval record.
Example therapy estimate
The same lines the job will be invoiced for, without the deposit or credits. Keep quantities visible so the client sees what changes if the scope changes.
| Description | Qty × rate | Amount |
|---|
| Mar 3: Psychotherapy, 60 min, CPT 90837 | 1 × $150.00 | $150.00 |
| Mar 10: Psychotherapy, 60 min, CPT 90837 | 1 × $150.00 | $150.00 |
| Mar 17: Psychotherapy, 45 min, CPT 90834 | 1 × $130.00 | $130.00 |
| Mar 24: Late cancellation (under 24 h, not reimbursable) | 1 × $75.00 | $75.00 |
| Payments received Mar 3, 10, 17 | | −$430.00 |
| Total due | $75.00 |
How to use the template
- Download the PDFFillable form, opens in any PDF reader on a computer or phone.
- Fill in your details onceHeader, terms and deposit rule. Save it as your master copy.
- Add the job and sendLines, quantities, valid-until date. Export and send; when the client says yes, turn it into the invoice.
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Questions
What is the difference between an estimate and a quote?
An estimate is an educated approximation that can change when the scope changes; a quote is a fixed price the client accepts. Call the document an Estimate unless you are prepared to hold the number. Both should have an expiry date.
How long should an estimate be valid?
30 days is standard for trades; 14 days if material prices move quickly. Put the date on the document so an old estimate cannot be accepted months later.
Should I ask for a deposit on an estimate?
Yes for new clients and for jobs with materials: state the deposit on the estimate (commonly 25-50%) so it is agreed before work starts, then show it as a credit on the invoice.
Can I turn this estimate into an invoice?
Yes. Keep the line items, change the title, remove the expiry line, add the invoice number and due date, and subtract any deposit received. An app that does this in one tap saves retyping every job.
Does this estimate template work for therapy jobs of any size?
Yes. For small jobs use three or four lines; for larger ones add a scope paragraph in the notes and bill by milestone. The matching therapy invoice template uses the same layout.
Invoice for the same trade
Estimate templates for related trades