Quotation Estimate Doctor General Practitioner in India Mumbai –Free Word Template Download with AI

Quotation Estimate No.: QTE/MUM/2025/00472
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 Prepared For:
Mr. Amit Deshmukh
14, Lotus Residency, Andheri West
Mumbai – 400053, Maharashtra, India
Contact: +91-98765-XXXXX 1. Purpose of This Quotation Estimate

This Quotation Estimate is issued by Dr. Rajesh K. Sharma, a registered Doctor General Practitioner practising in India Mumbai, to provide a comprehensive and transparent breakdown of professional medical consultation, diagnostic, and follow-up services. This document serves as a formal cost estimate for the patient or the patient's authorised representative. All charges listed herein are in Indian Rupees (INR) and are subject to the terms and conditions outlined in Section 7 of this Quotation Estimate. The Doctor General Practitioner reserves the right to revise this estimate should the scope of treatment change materially after the initial assessment in India Mumbai.

2. Scope of Services – Doctor General Practitioner

The following services are provided by the Doctor General Practitioner at the Shanti Clinic & Wellness Centre, located in the heart of India Mumbai. The Doctor General Practitioner holds over twenty-two years of clinical experience in general medicine, preventive healthcare, chronic disease management, and primary care for all age groups. This Quotation Estimate covers a complete cycle of primary medical care as detailed below.

3. Itemised Charges

S.No.	Description of Service	Quantity / Frequency	Unit Rate (INR)	Amount (INR)	Remarks
1	Initial Consultation with Doctor General Practitioner (comprehensive history, physical examination, and preliminary diagnosis)	1 session (45 min)	₹ 1,200	₹ 1,200	Includes prescription
2	Follow-up Consultation with Doctor General Practitioner (review of progress, medication adjustment)	4 sessions (30 min each)	₹ 800	₹ 3,200	Bi-weekly visits
3	Complete Blood Count (CBC), Liver Function Test (LFT), Kidney Function Test (KFT), Lipid Profile, and Fasting Blood Sugar	1 panel	₹ 2,800	₹ 2,800	Lab partner: SRL Diagnostics, Mumbai
4	Chest X-Ray (PA View) and 12-Lead ECG	1 set	₹ 1,500	₹ 1,500	On-site imaging at clinic
5	Urine Routine & Microscopy	1 test	₹ 450	₹ 450	—
6	Prescribed Medications for 30 days (as per Doctor General Practitioner's prescription)	1 month supply	₹ 3,500	₹ 3,500	Approximate; actual may vary
7	Home Visit by Doctor General Practitioner (within Mumbai city limits, up to 10 km radius)	2 visits	₹ 1,000	₹ 2,000	After-hours surcharge applies
8	Health Education & Lifestyle Counselling (dietary guidance, exercise plan, smoking cessation support)	1 session (60 min)	₹ 1,000	₹ 1,000	Includes printed material
9	Referral Coordination & Specialist Follow-up Management (if required by Doctor General Practitioner)	1 instance	₹ 500	₹ 500	Administrative fee only
10	Annual Health Check-up Package (comprehensive screening for age 40–60, as recommended by Doctor General Practitioner)	1 package	₹ 8,500	₹ 8,500	Includes 20+ parameters
Grand Total (Inclusive of all applicable taxes)				₹ 25,250	—

Note: The above Quotation Estimate is based on the current fee structure of the Doctor General Practitioner in India Mumbai as of June 2025. Medication costs (Item 6) are approximate and may vary depending on the specific brands dispensed by the pharmacy. All diagnostic tests are conducted at NABL-accredited laboratories in Mumbai. 4. Payment Terms

The total amount of ₹ 25,250 (Twenty-Five Thousand Two Hundred and Fifty Indian Rupees) shall be payable as follows:

Advance Payment (50%): ₹ 12,625 – due at the time of accepting this Quotation Estimate.
Balance Payment (50%): ₹ 12,625 – due upon completion of the final follow-up consultation or home visit, whichever is later.

Accepted modes of payment include: NEFT/RTGS, UPI (Google Pay, PhonePe, Paytm), credit/debit cards (Visa, Mastercard, RuPay), and bank transfer to the account of the Doctor General Practitioner's registered clinic in Mumbai, India. A GST invoice at 5% (as applicable for medical services in India) will be issued upon full payment.

5. Validity & Acceptance

This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Beyond this period, the Doctor General Practitioner reserves the right to revise the charges due to changes in diagnostic lab rates, pharmaceutical pricing, or regulatory updates in India Mumbai. Acceptance of this Quotation Estimate may be communicated in writing via email or signed acknowledgment at the clinic reception.

6. Cancellation & Rescheduling Policy

In the event the patient wishes to cancel or reschedule any appointment with the Doctor General Practitioner, a minimum of 24 hours' prior notice is required. Cancellations made within 24 hours of a scheduled visit will incur a 25% fee of the respective session charge. Unused diagnostic tests that have already been processed by the laboratory cannot be refunded. This policy is standard practice for a Doctor General Practitioner's clinic in India Mumbai and is designed to ensure efficient utilisation of clinical resources.

7. Terms & Conditions

This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Doctor General Practitioner will exercise reasonable clinical judgement in the best interest of the patient at all times.
All medical records, prescriptions, and diagnostic reports generated during the course of treatment will be maintained at the clinic in Mumbai, India, in compliance with the Digital Personal Data Protection Act, 2023, and the Medical Council of India (now National Medical Commission) regulations.
The Doctor General Practitioner may, at their clinical discretion, recommend additional investigations, specialist referrals, or modifications to the treatment plan. Any such additions will be communicated to the patient in writing and will be billed separately beyond the scope of this Quotation Estimate.
Emergency or after-hours consultations (outside 09:00–18:00 IST, Monday to Saturday) will attract an additional 50% surcharge on the standard consultation fee.
This Quotation Estimate is non-transferable and is issued specifically for the named patient. It cannot be assigned to a third party without prior written consent from the Doctor General Practitioner.
In the event of any dispute arising from the services described in this Quotation Estimate, both parties agree to first attempt resolution through amicable discussion. If unresolved, the matter shall be subject to the jurisdiction of the competent civil courts in Mumbai, Maharashtra, India.
The Doctor General Practitioner is registered with the Maharashtra State Medical Council and carries professional indemnity insurance covering all services rendered in India Mumbai.

8. Declaration

I, Dr. Rajesh K. Sharma, hereby confirm that this Quotation Estimate accurately reflects the standard fees and service charges of my practice as a Doctor General Practitioner in India Mumbai. All services will be rendered with the highest standards of medical ethics, patient confidentiality, and clinical excellence in accordance with the guidelines of the National Medical Commission of India.

For & On Behalf of the Doctor General Practitioner
Dr. Rajesh K. Sharma, MD
Shanti Clinic & Wellness Centre, Mumbai, India
Date: _______________ Patient / Authorised Representative
Name: Mr. Amit Deshmukh
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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