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Purchase Order Ophthalmologist in Canada Toronto –Free Word Template Download with AI

Northlake Vision Care Group Inc.

1200 Bay Street, Suite 4500, Toronto, Ontario, Canada M5G 2A1

Phone: (416) 555-0192  |  Email: [email protected]

Business Number: 123456789RT0001

Purchase Order No.: PO-2025-04872

Date of Issue: June 12, 2025

Required Delivery Date: July 15, 2025

Payment Terms: Net 30 Days

Currency: Canadian Dollars (CAD)

Incoterms: DAP Toronto, Canada

Prepared By: Margaret Chen, Procurement Manager

Department: Ophthalmology Services Division

Valid Until: August 12, 2025

Dr. Alexander R. Whitfield, Ophthalmologist

Whitfield Ophthalmology Associates Ltd.

88 Queen Street West, Floor 12, Toronto, Ontario, Canada M5H 2N1

Phone: (416) 555-0347  |  Fax: (416) 555-0348

Email: [email protected]

College of Physicians and Surgeons of Ontario (CPSO) License No.: 48291

Business Number: 987654321RT0001

Northlake Vision Care Group Inc. – Procurement Department

1200 Bay Street, Suite 4500, Toronto, Ontario, Canada M5G 2A1

Attn: Margaret Chen, Procurement Manager

Phone: (416) 555-0192

Item # Description Category Qty Unit Price (CAD) Amount (CAD)
001 Comprehensive Ophthalmologist Consultation – Diagnostic Eye Examination (per patient session, 45 min) Professional Service 120 $285.00 $34,200.00
002 Optical Coherence Tomography (OCT) Imaging – Performed by Ophthalmologist Diagnostic Imaging 200 $145.00 $29,000.00
003 Cataract Surgery – Phacoemulsification with Intraocular Lens Implant (per procedure) Surgical Procedure 35 $4,850.00 $169,750.00
004 Retinal Laser Photocoagulation Treatment – Administered by Ophthalmologist Therapeutic Procedure 60 $1,200.00 $72,000.00
005 Topical Anesthetic and Post-Operative Eye Drop Kits (per patient) Medical Supplies 35 $85.00 $2,975.00
006 Post-Operative Follow-Up Visits with Ophthalmologist (3 visits per patient) Professional Service 105 $150.00 $15,750.00
007 Visual Field Perimetry Testing – Administered under Ophthalmologist Supervision Diagnostic Service 80 $95.00 $7,600.00
008 Anterior Segment Biometry and Corneal Topography Mapping Diagnostic Service 35 $110.00 $3,850.00

Subtotal: $335,125.00 CAD

HST (13% – Ontario, Canada): $43,566.25 CAD

Grand Total: $378,691.25 CAD

  1. This Purchase Order is issued by Northlake Vision Care Group Inc. (hereinafter referred to as "the Purchaser") and is directed to Dr. Alexander R. Whitfield, Ophthalmologist, operating under Whitfield Ophthalmology Associates Ltd. (hereinafter referred to as "the Ophthalmologist" or "the Vendor") for the provision of ophthalmology services and associated medical supplies in Canada Toronto.
  2. All services described in this Purchase Order shall be performed in accordance with the standards established by the College of Physicians and Surgeons of Ontario (CPSO) and the Ontario Health Insurance Plan (OHIP) guidelines where applicable. The Ophthalmologist warrants that all procedures will be conducted in full compliance with provincial and federal Canadian medical regulations.
  3. Delivery of all physical supplies, including anesthetic kits and post-operative materials, shall be made to the Purchaser's facility located at 1200 Bay Street, Toronto, Ontario, Canada. The Ophthalmologist or their designated logistics partner shall bear all shipping and handling costs up to the point of delivery in Canada Toronto.
  4. Payment shall be made within thirty (30) calendar days of receipt of a valid invoice from the Ophthalmologist. Invoices must reference this Purchase Order number (PO-2025-04872) and include the Vendor's Business Number for tax compliance purposes under the Canada Revenue Agency (CRA) regulations.
  5. The Ophthalmologist shall maintain valid professional liability insurance with a minimum coverage of $5,000,000 CAD throughout the duration of this Purchase Order. A certificate of insurance shall be provided to the Purchaser prior to the commencement of any surgical or therapeutic procedures.
  6. All patient data and medical records generated as a result of services under this Purchase Order shall be handled in strict accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Ontario Health Information Act (OHIA). The Ophthalmologist shall not disclose any patient information to third parties without written consent from the patient and the Purchaser.
  7. Any changes, modifications, or cancellations to this Purchase Order must be made in writing and signed by both the Purchaser's authorized representative and the Ophthalmologist. Verbal agreements shall not constitute a valid amendment to this document.
  8. In the event of a dispute arising from this Purchase Order, both parties agree to first attempt resolution through good-faith negotiation. Should negotiation fail, the matter shall be submitted to mediation under the rules of the Ontario Arbitration Association, with the venue set in Toronto, Canada.
  9. This Purchase Order is governed by and shall be interpreted in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein.
  10. The Ophthalmologist acknowledges that all services rendered under this Purchase Order are subject to the Purchaser's quality assurance review. The Purchaser reserves the right to audit service delivery records, billing accuracy, and compliance with the terms outlined herein upon thirty (30) days' written notice.

By signing below, both parties acknowledge and agree to the terms, conditions, and line items specified in this Purchase Order for ophthalmology services to be delivered in Canada Toronto.

For the Purchaser:

Northlake Vision Care Group Inc.

Name: Margaret Chen

Title: Procurement Manager

Date: ____________________

For the Ophthalmologist / Vendor:

Whitfield Ophthalmology Associates Ltd.

Name: Dr. Alexander R. Whitfield, Ophthalmologist

Title: Principal Physician

Date: ____________________

This Purchase Order (PO-2025-04872) is a legally binding document issued by Northlake Vision Care Group Inc. for the procurement of Ophthalmologist services in Canada Toronto. Unauthorized reproduction or distribution is prohibited. All amounts are stated in Canadian Dollars (CAD) and are subject to applicable Ontario HST. For inquiries, contact the Procurement Department at [email protected] or (416) 555-0192.

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