Quotation Estimate Doctor General Practitioner in Senegal Dakar –Free Word Template Download with AI
Medical Services & General Practice Consultation
Senegal Dakar
Provider
Dr. Awa Ndiaye, MD
Doctor General Practitioner
Cabinet Médical Ndiaye
12, Avenue Cheikh Anta Diop
Plateau, Dakar, Senegal
Tel: +221 33 800 12 34
Email: [email protected]
License No. DGP-SN-2019-0847
Client / Recipient
M. Ibrahima Sow
Private Individual
45, Rue Félix Faure
Mermoz, Dakar, Senegal
Tel: +221 77 555 67 89
Email: [email protected]
National ID: SN-1985-04421
This Quotation Estimate is issued by Dr. Awa Ndiaye, a licensed Doctor General Practitioner operating in Senegal Dakar, to provide a comprehensive breakdown of anticipated medical services, diagnostic procedures, and follow-up consultations. The Doctor General Practitioner in Senegal Dakar is committed to delivering accessible, high-quality primary healthcare to all patients within the greater Dakar metropolitan area. This document serves as a formal Quotation Estimate outlining all costs associated with the recommended course of care.
| Ref | Service / Procedure | Description | Qty | Unit Price (XOF) | Total (XOF) |
|---|---|---|---|---|---|
| 01 | Initial General Consultation | Comprehensive medical history, physical examination, and preliminary diagnosis by the Doctor General Practitioner | 1 | 25,000 | 25,000 |
| 02 | Follow-Up Consultation (per session) | Subsequent visits for treatment monitoring, medication adjustment, and progress assessment | 4 | 18,000 | 72,000 |
| 03 | Complete Blood Count (CBC) & Biochemistry Panel | Laboratory analysis including hemoglobin, white blood cells, glucose, liver and kidney function tests | 1 | 35,000 | 35,000 |
| 04 | Chest X-Ray (Bilateral) | Imaging diagnostic performed at the on-site radiology unit in Senegal Dakar | 1 | 45,000 | 45,000 |
| 05 | Electrocardiogram (ECG / EKG) | Cardiac rhythm assessment and interpretation by the Doctor General Practitioner | 1 | 20,000 | 20,000 |
| 06 | Prescribed Medication (30-day supply) | Pharmaceuticals as prescribed following diagnosis, dispensed through the Senegal Dakar pharmacy network | 1 | 55,000 | 55,000 |
| 07 | Urgent / After-Hours Consultation | Emergency availability of the Doctor General Practitioner outside standard clinic hours (Sat–Sun & evenings) | 1 | 40,000 | 40,000 |
| 08 | Home Visit (Dakar Metropolitan Area) | On-site consultation at the patient's residence within Senegal Dakar city limits | 1 | 35,000 | 35,000 |
| 09 | Medical Certificate / Referral Letter | Official documentation for employer, insurance, or specialist referral within Senegal Dakar health network | 2 | 5,000 | 10,000 |
| 10 | Annual Preventive Health Screening | Comprehensive yearly check-up including blood pressure, BMI, cholesterol, and age-appropriate screenings | 1 | 60,000 | 60,000 |
| GRAND TOTAL (Quotation Estimate) | 397,000 XOF | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, the Doctor General Practitioner reserves the right to revise pricing based on current market conditions in Senegal Dakar.
- Payment is due within fourteen (14) days of the date of this Quotation Estimate. Accepted payment methods include bank transfer (Banque Populaire du Sénégal, Société Générale Sénégal), mobile money (Orange Money, Wave), and cash at the clinic reception in Senegal Dakar.
- A deposit of 30% of the total Quotation Estimate amount is required to confirm the booking of all scheduled consultations and diagnostic procedures.
- The Doctor General Practitioner in Senegal Dakar shall provide a detailed itemized invoice upon completion of each service. The final invoice shall not exceed the total amount stated in this Quotation Estimate unless additional services are mutually agreed upon in writing.
- All medical records and diagnostic results generated under this Quotation Estimate shall be maintained in accordance with Senegalese health data protection regulations (Loi n° 2008-12 du 25 janvier 2008 relative à la protection des données à caractère personnel).
- In the event of a medical emergency requiring referral to a specialist or hospital within Senegal Dakar (e.g., Hôpital Principal de Dakar, Centre Hospitalier National de Pikine), the Doctor General Practitioner will coordinate the transfer and provide a written referral. Specialist and hospital fees are not included in this Quotation Estimate.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Doctor General Practitioner will exercise all reasonable professional judgment in the delivery of care.
- Disputes arising from this Quotation Estimate shall be resolved through amicable negotiation. In the absence of resolution, matters shall be submitted to the competent courts of Dakar, Senegal.
By signing below, the client acknowledges receipt of this Quotation Estimate and authorizes the Doctor General Practitioner to proceed with the services described herein. The client confirms that all medical information provided during consultations in Senegal Dakar has been given in good faith and is accurate to the best of their knowledge.
Dr. Awa Ndiaye, MDDoctor General Practitioner
Cabinet Médical Ndiaye, Senegal Dakar
Date: _______________ M. Ibrahima Sow
Client / Patient
Senegal Dakar
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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