Quotation Estimate Doctor General Practitioner in Philippines Manila –Free Word Template Download with AI
Doctor General Practitioner Services — Philippines Manila
Provider
Dr. Maria L. Santos, M.D., F.P.S.G.P.
Doctor General Practitioner
Santos General Practice Clinic
128 Makati Avenue, Salcedo Village
Makati City, Metro Manila, Philippines
Tel: (+63) 2 8887-4521
Email: [email protected]
PRC License No. 2847-5612
Client / Recipient
Mr. Juan R. Dela Cruz
Corporate Wellness Program
Delacruz Industries, Inc.
Unit 1402, Ayala Center
Makati City, Metro Manila, Philippines
Tel: (+63) 917 555-0192
Email: [email protected]
| Quotation Estimate No. | QTE-2025-0417-MNL | Date Issued | June 15, 2025 |
| Validity Period | 30 days (until July 15, 2025) | Currency | Philippine Peso (PHP) |
| Service Location | Santos General Practice Clinic, Makati City, Philippines Manila | ||
This Quotation Estimate is issued by Dr. Maria L. Santos, a licensed Doctor General Practitioner registered with the Philippine Board of General Practice, to provide comprehensive primary care medical services to the client and its designated employees. All consultations, diagnostics, and follow-up care shall be conducted at the clinic premises located in Philippines Manila, specifically in the Makati City district of Metro Manila. The Doctor General Practitioner will serve as the primary point of contact for all non-specialized medical needs, including preventive health screenings, chronic disease management, minor surgical procedures, and referral coordination to specialist physicians when clinically indicated.
| No. | Description of Service | Frequency | Unit Rate (PHP) | Total (PHP) |
|---|---|---|---|---|
| 1 | Initial Comprehensive Medical Consultation by Doctor General Practitioner (includes history-taking, physical examination, and preliminary assessment) | Per session | 2,500.00 | 2,500.00 |
| 2 | Follow-up Consultation with Doctor General Practitioner (subsequent visits for treatment monitoring and adjustment) | Per session | 1,800.00 | 1,800.00 |
| 3 | Annual Preventive Health Screening Package (CBC, lipid panel, fasting glucose, liver function, renal panel, urinalysis, chest X-ray, and ECG) | Annual | 8,500.00 | 8,500.00 |
| 4 | Chronic Disease Management Program (hypertension, type 2 diabetes, or dyslipidemia) including quarterly check-ups and medication review by Doctor General Practitioner | Quarterly (4x/yr) | 3,200.00 | 12,800.00 |
| 5 | Minor In-Office Procedures (wound suturing, joint aspiration, intramuscular injections, skin lesion excision) performed by Doctor General Practitioner | As needed | 1,500.00 | 1,500.00 |
| 6 | Health Risk Assessment and Lifestyle Counseling Session (nutrition, exercise, and stress management guidance) | Bi-annual | 2,000.00 | 4,000.00 |
| 7 | Medical Certificate and Referral Letter Issuance (for insurance claims, travel, or specialist referral within Philippines Manila) | Per document | 500.00 | 500.00 |
| 8 | Telemedicine / Virtual Consultation with Doctor General Practitioner (via secure video platform for non-urgent follow-ups) | Per session | 1,200.00 | 1,200.00 |
| 9 | Emergency After-Hours Consultation (weekends and public holidays, 7:00 PM to 7:00 AM) by Doctor General Practitioner on call | As needed | 4,000.00 | 4,000.00 |
| 10 | Corporate Wellness Seminar and On-Site Health Fair (half-day event for up to 50 employees, conducted at client premises in Philippines Manila) | Annual | 25,000.00 | 25,000.00 |
| SUBTOTAL | 61,800.00 | |||
| VAT (12%) | 7,416.00 | |||
| GRAND TOTAL (PHP) | 69,216.00 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. Any services rendered after the expiration date shall be subject to revised pricing as determined by the Doctor General Practitioner.
- All fees are quoted in Philippine Pesos (PHP) and are inclusive of standard consultation charges. Additional laboratory tests, imaging studies, or specialist referrals beyond the scope listed above shall be billed separately at prevailing rates in Philippines Manila.
- Payment terms: Fifty percent (50%) of the total amount shall be due upon acceptance of this Quotation Estimate. The remaining fifty percent (50%) shall be settled within fifteen (15) days from the completion of the contracted service period.
- The Doctor General Practitioner reserves the right to refer the patient to a specialist physician if the clinical condition warrants specialized care. Referral fees and specialist consultation charges are not included in this Quotation Estimate.
- All medical records and patient data shall be handled in strict accordance with the Philippine Data Privacy Act of 2012 (Republic Act No. 10173) and the standards set by the Philippine Medical Association.
- Cancellation or rescheduling of appointments must be made at least twenty-four (24) hours in advance. Late cancellations or no-shows shall be subject to a 50% fee of the scheduled consultation rate.
- This Quotation Estimate does not constitute a binding contract until both parties have signed and affixed their respective seals. Upon execution, it shall serve as the governing document for the professional services rendered by the Doctor General Practitioner in Philippines Manila.
- Any disputes arising from this Quotation Estimate shall be resolved through amicable negotiation. In the event of unresolved disagreement, the parties agree to submit the matter to the Philippine Medical Association's dispute resolution panel or to the appropriate courts of jurisdiction in Metro Manila, Philippines.
By signing below, both parties acknowledge and agree to the terms, conditions, and charges outlined in this Quotation Estimate for Doctor General Practitioner services in Philippines Manila.
Prepared by:
Dr. Maria L. Santos, M.D., F.P.S.G.P.Doctor General Practitioner
Date: ______________________
Accepted by:
Mr. Juan R. Dela CruzAuthorized Representative, Delacruz Industries, Inc.
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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