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Quotation Estimate Doctor General Practitioner in Israel Jerusalem –Free Word Template Download with AI

Doctor General Practitioner Services | Israel Jerusalem

12 King George Street, Jerusalem 97100, Israel

Tel: +972-2-623-4567 | Email: [email protected]

License No. IL-MED-2024-08834 | Ministry of Health, State of Israel

Quotation Estimate

Quotation Details

Quotation Estimate No.: QTE-JER-2025-0417

Date of Issue: 15 June 2025

Valid Until: 15 July 2025 (30 days)

Prepared By: Dr. Sarah Levi, Doctor General Practitioner

Location: Israel Jerusalem

Client Information

Client Name: [Client Full Name]

Address: [Client Address], Israel

Phone: [Client Phone Number]

Email: [Client Email Address]

Insurance Provider: [Maccabi / Clalit / Meuhedet / Hasked]

This Quotation Estimate is issued by the Jerusalem Medical Practice Center, a licensed medical facility operating in Israel Jerusalem, to provide a comprehensive and transparent breakdown of anticipated costs for services rendered by our Doctor General Practitioner. This document serves as a formal estimate and does not constitute a binding invoice until accepted in writing by the client. All pricing reflects current rates as of the date of issue and is subject to the terms outlined below.

# Service Description Duration Unit Price (NIS) Total (NIS)
1 Initial Doctor General Practitioner Consultation – Comprehensive health assessment, medical history review, and physical examination conducted in Israel Jerusalem 45 minutes 450.00 450.00
2 Follow-up Doctor General Practitioner Visit – Review of initial findings, discussion of treatment plan, and prescription management 30 minutes 300.00 300.00
3 Full Blood Panel (CBC, Lipid Profile, Liver & Kidney Function, Thyroid Panel) – Laboratory work coordinated through our Israel Jerusalem partner lab 1 session 680.00 680.00
4 Electrocardiogram (ECG) and Basic Cardiac Screening – Performed on-site by the Doctor General Practitioner team 20 minutes 350.00 350.00
5 Chest X-Ray (PA View) – Radiology service available at our Israel Jerusalem facility 15 minutes 420.00 420.00
6 Preventive Health Screening & Vaccination Consultation – Age-appropriate immunizations and lifestyle counseling by the Doctor General Practitioner 25 minutes 250.00 250.00
7 Written Medical Report & Treatment Plan – Detailed documentation prepared by the Doctor General Practitioner for the client's personal records or insurance submission 1 document 180.00 180.00
8 Administrative & Facility Fee – Covers use of examination rooms, sterilization, and medical record management at our Israel Jerusalem clinic Per visit 75.00 225.00
Subtotal (NIS) 2,955.00
VAT (18%) 531.90
TOTAL ESTIMATED COST (NIS) 3,486.90
# Service Price (NIS) Notes
A Home Visit by Doctor General Practitioner within Jerusalem city limits 550.00 Subject to availability
B Urgent / After-Hours Doctor General Practitioner Consultation 600.00 Sat–Sun & holidays
C Specialist Referral Coordination (Cardiology, Dermatology, etc.) 150.00 Referral fee only
D Telemedicine Follow-up with Doctor General Practitioner 200.00 Video consultation
  1. This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be adjusted to reflect changes in medical supply costs, labor rates, or regulatory updates in Israel Jerusalem.
  2. All services listed are to be performed by or under the direct supervision of a licensed Doctor General Practitioner registered with the Israeli Medical Association and the Ministry of Health of the State of Israel.
  3. The final invoice may differ from this Quotation Estimate by no more than ten percent (10%) unless additional procedures are requested by the client or medically necessitated during the consultation. Any such deviation will be communicated to the client prior to execution.
  4. Payment is due within fourteen (14) days of the date of the final invoice. Accepted payment methods include bank transfer (NIS, USD, EUR), credit card (Visa, Mastercard), and cash at our Israel Jerusalem office.
  5. Insurance claims: The Doctor General Practitioner will provide all necessary documentation for submission to the client's health fund (Maccabi, Clalit, Meuhedet, or Hasked). Reimbursement timelines are governed by the respective insurance provider and are outside the control of this practice.
  6. This Quotation Estimate does not guarantee specific medical outcomes. The Doctor General Practitioner will exercise professional judgment in determining the most appropriate course of treatment based on clinical findings.
  7. All patient data and medical records are handled in strict compliance with the Israeli Privacy Protection Law, 5741-1981, and the regulations of the Ministry of Health in Israel Jerusalem.
  8. Cancellation of scheduled appointments must be made at least twenty-four (24) hours in advance. Late cancellations or no-shows will be subject to a fee of fifty percent (50%) of the scheduled consultation rate.
  9. This Quotation Estimate is non-transferable and is issued exclusively for the client named above. Any change in client identity requires a new Quotation Estimate to be generated.
  10. Disputes arising from this Quotation Estimate or the services described herein shall be governed by the laws of the State of Israel, with jurisdiction vested in the courts of Jerusalem, Israel.

By signing below, the client acknowledges receipt of this Quotation Estimate for Doctor General Practitioner services at the Jerusalem Medical Practice Center, Israel Jerusalem, and authorizes the provision of the services described herein subject to the terms and conditions stated above.

Client Signature

Name: _________________________ Date: _______________

Dr. Sarah Levi – Doctor General Practitioner

Jerusalem Medical Practice Center, Israel Jerusalem

Date: 15 June 2025

Jerusalem Medical Practice Center | 12 King George Street, Jerusalem 97100, Israel

Quotation Estimate No. QTE-JER-2025-0417 | This document is electronically generated and valid without a physical stamp.

© 2025 Jerusalem Medical Practice Center. All rights reserved.

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