Chiropractor Estimate Template
A chiropractor estimate forecasts the price before work starts: 7 lines for a new patient with low back pain: exam, lumbar X-rays, six adjustments and two kinds of therapy, totalling $674.00, with services the largest share (92%). It states its assumptions and stays valid for 30 days. Edit the lines and download the PDF.
Pre-filled for a chiropractor: a new patient with low back pain: exam, lumbar x-rays, six adjustments and two kinds of therapy. Example prices: replace them with your own.
From
Granite Chiropractic
525 Market Street
Salem, MA 01970
billing@example.com
(512) 555-0125
Estimate
Prepared for
Dana Whitfield
14 Elm Street
Franklin, TN 37064
client@example.com
| Description | Qty | Rate | Amount |
|---|---|---|---|
| New patient exam and consultation | 1 visit | $95.00 | $95.00 |
| Lumbar X-rays, two views | 1 each | $85.00 | $85.00 |
| Spinal adjustment, 1-2 regions (CPT 98940)Lumbar and pelvic | 6 visit | $55.00 | $330.00 |
| Electrical muscle stimulation, unattended | 3 visit | $20.00 | $60.00 |
| Therapeutic ultrasound (CPT 97035) | 2 15 min | $25.00 | $50.00 |
| Lumbar support belt | 1 each | $39.00 | $39.00 |
| Reusable cold therapy pack | 1 each | $15.00 | $15.00 |
- Subtotal
- $674.00
- Estimate total
- $674.00
Notes
A chiropractic estimate should present the recommended care plan as a schedule (visits per week for how many weeks), the per-visit and prepaid prices, and which X-rays or therapies are included.
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Chiropractor estimate at a glance
| Scope estimated | A new patient with low back pain: exam, lumbar X-rays, six adjustments and two kinds of therapy |
|---|---|
| Estimate total | $674.00 before tax |
| Valid for | 30 days from the estimate date |
| Deposit | Prepaid care plans are paid in full or in installments before the series of visits begins, usually at a discount to the single-visit price. |
| Services (5 lines) | $620.00, 92% |
| Products (2 lines) | $54.00, 8% |
| Priced in | visit |
Estimate breakdown for a new patient with low back pain: exam, lumbar X-rays, six adjustments and two kinds of therapy
| Item | Type | Est. quantity | Est. amount |
|---|---|---|---|
| New patient exam and consultation | Services | 1 visit | $95.00 |
| Lumbar X-rays, two views | Services | 1 each | $85.00 |
| Spinal adjustment, 1-2 regions (CPT 98940) | Services | 6 visit | $330.00 |
| Electrical muscle stimulation, unattended | Services | 3 visit | $60.00 |
| Therapeutic ultrasound (CPT 97035) | Services | 2 15 min | $50.00 |
| Lumbar support belt | Products | 1 each | $39.00 |
| Reusable cold therapy pack | Products | 1 each | $15.00 |
| Estimated total | $674.00 |
What to write on a chiropractor estimate
A chiropractic estimate should present the recommended care plan as a schedule (visits per week for how many weeks), the per-visit and prepaid prices, and which X-rays or therapies are included.
Materials and products are $54.00 of this $674.00 estimate (8%), so say how long those prices hold: supplier prices can move before the job starts.
Charges per adjustment visit, with a higher new-patient exam fee, X-rays and therapies priced separately and prepaid care plans sold at a per-visit discount.
Assumptions behind each line
Write these next to the 7 lines so the customer sees what the $674.00 depends on.
- New patient exam and consultation: 1 visit, $95.00.
- Lumbar X-rays, two views: 1 each, $85.00.
- Spinal adjustment, 1-2 regions (CPT 98940): 6 visit, $330.00.
- Electrical muscle stimulation, unattended: 3 visit, $60.00.
- Therapeutic ultrasound (CPT 97035): 2 15 min, $50.00.
- Lumbar support belt: 1 each at $39.00 ($39.00); another grade or brand changes this line.
- Reusable cold therapy pack: 1 each at $15.00 ($15.00); another grade or brand changes this line.
Changes, overruns and change orders
If the customer adds work, put it on a signed change order first. Pricing the extra in visit keeps it comparable with the $674.00 you estimated.
A 10% rise in material prices would add $5.40 to this job, which is why many chiropractors limit how long an estimate stays valid.
Tips from chiropractic care billing
- Code adjustments by the number of spinal regions treated (98940 for one or two, 98941 for three or four, 98942 for five) and name the regions on the line, so the invoice itself supports the code.
- A prepaid care plan invoice should show the total paid, the visits used and the value per visit, because a patient who stops halfway will ask what the unused visits are worth.
- For auto-accident or workers' compensation cases, put the claim number, the adjuster and the date of injury in the header, and bill that payer separately from the patient's own visits.
- Charge X-rays as their own line with the views taken, since patients who arrive with recent imaging from elsewhere expect that line to disappear.
Turning the chiropractor estimate into an invoice
-
Get it approved
Ask Dana Whitfield to sign or reply in writing to estimate EST-6562.
-
Record the changes
Update quantities to what was actually used across the 7 lines.
-
Switch the document type
Change Estimate to Invoice in the tool; the lines and parties stay.
-
Deduct what was paid
Enter any deposit as amount paid so the balance due is correct.
Frequently asked questions
How do I write a chiropractor estimate?
Describe the job (A new patient with low back pain: exam, lumbar X-rays, six adjustments and two kinds of therapy), list each line with an estimated quantity and rate, total it ($674.00 in the sample), state how long it is valid and what it assumes, then send it as a PDF for approval.
Is a chiropractor estimate binding?
An estimate is a forecast, not a fixed price, so the final invoice can differ when the work or materials change. Rules vary by country and state; to stay safe, get written approval before billing noticeably more than the $674.00 you estimated.
How long should a chiropractor estimate be valid?
Thirty days is common and is what this template uses. With 8% of the price in materials, a shorter validity protects you if supplier prices rise.