Quotation Estimate Doctor General Practitioner in Sri Lanka Colombo –Free Word Template Download with AI
Doctor General Practitioner Services — Colombo, Sri Lanka
Provided By
Colombo General Practice Clinic
No. 42, Galle Road, Colombo 03
Sri Lanka
Tel: +94 11 234 5678
Email: [email protected]
License No: SL-MED-2024-0891
Prepared For
Client / Patient Name: [To be filled]
Address: [To be filled], Colombo
Sri Lanka
Tel: [To be filled]
Email: [To be filled]
| Quotation Estimate No. | QTE-2025-CGP-0047 | Date of Issue | 15 June 2025 |
| Validity Period | 30 Days (until 15 July 2025) | Currency | Sri Lankan Rupee (LKR) |
| Service Category | Doctor General Practitioner — Outpatient & Preventive Care | ||
This Quotation Estimate is issued by Colombo General Practice Clinic to provide a comprehensive breakdown of costs associated with the services of a Doctor General Practitioner operating in Sri Lanka Colombo. The Doctor General Practitioner referenced herein is a fully licensed medical professional registered with the Medical Secretariat of Sri Lanka, possessing a minimum of ten (10) years of clinical experience in primary and preventive healthcare. All services are delivered at the clinic premises located on Galle Road, Colombo 03, and are subject to the regulatory standards set by the Ministry of Health, Sri Lanka.
| No. | Description of Service | Frequency / Qty | Unit Rate (LKR) | Total (LKR) |
|---|---|---|---|---|
| 01 | Initial Consultation with Doctor General Practitioner (comprehensive history, physical examination, and preliminary diagnosis) | 1 Session (60 min) | 8,500 | 8,500 |
| 02 | Follow-up Consultation with Doctor General Practitioner (treatment review, medication adjustment, and progress assessment) | 4 Sessions (30 min each) | 5,500 | 22,000 |
| 03 | Full Blood Panel & Biochemistry Screening (FBC, LFT, RFT, Lipid Profile, HbA1c, Thyroid Panel) as ordered by the Doctor General Practitioner | 1 Package | 18,000 | 18,000 |
| 04 | Electrocardiogram (ECG) & Chest X-Ray (PA View) — performed under referral of the Doctor General Practitioner | 1 Package | 7,500 | 7,500 |
| 05 | Annual Health Check-Up Program (comprehensive screening, BMI assessment, blood pressure monitoring, and lifestyle counselling by the Doctor General Practitioner) | 1 Program | 25,000 | 25,000 |
| 06 | Prescription & Medication Guidance (including written treatment plan, dosage instructions, and dietary recommendations specific to the Colombo, Sri Lanka climate and local dietary patterns) | 1 Document | 2,000 | 2,000 |
| 07 | Home Visit by Doctor General Practitioner (for elderly or mobility-impaired patients within Colombo District, Sri Lanka) | 2 Visits (45 min each) | 12,000 | 24,000 |
| 08 | Telemedicine / Video Consultation with Doctor General Practitioner (for follow-ups, minor queries, and prescription renewals) | 3 Sessions (20 min each) | 3,500 | 10,500 |
| 09 | Vaccination Administration (adult immunization schedule as recommended by the Doctor General Practitioner, including flu, tetanus, and hepatitis B) | 3 Doses | 4,500 | 13,500 |
| 10 | Medical Certificate & Referral Letter (for insurance claims, employment purposes, or specialist referral within Colombo, Sri Lanka) | 2 Documents | 1,500 | 3,000 |
| SUBTOTAL | 134,000 | |||
| VAT (18% as per Sri Lankan tax regulations) | 24,120 | |||
| GRAND TOTAL | 158,120 | |||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, the Doctor General Practitioner reserves the right to revise fees in accordance with prevailing market rates in Sri Lanka Colombo.
- Payment is due within fourteen (14) days of acceptance of this Quotation Estimate. Accepted payment methods include bank transfer (Commercial Bank, Bank of Ceylon, or HNB), cash, and major credit/debit cards processed at the Colombo clinic reception.
- A 50% advance payment is required to confirm the booking of the Doctor General Practitioner's schedule. The remaining balance shall be settled upon completion of all listed services.
- All medical services provided by the Doctor General Practitioner are governed by the Medical Secretariat Act of Sri Lanka and the ethical code of the Sri Lanka Medical Association. Patient confidentiality is maintained in strict accordance with Sri Lankan data protection regulations.
- The Doctor General Practitioner may, at their clinical discretion, modify the treatment plan. Any additional procedures will be documented in a supplementary Quotation Estimate and require written client approval before execution.
- Home visits by the Doctor General Practitioner are limited to the Colombo District (Colombo 01 through Colombo 15). Travel to areas outside this zone will incur an additional transport surcharge of LKR 2,000 per visit.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Doctor General Practitioner will exercise the highest standard of care consistent with accepted medical practice in Sri Lanka.
- Any disputes arising from this Quotation Estimate shall be resolved through amicable negotiation. In the event of unresolved disagreement, the matter shall be subject to the jurisdiction of the Colombo District Court, Sri Lanka.
By signing below, the client acknowledges and accepts the terms, conditions, and pricing outlined in this Quotation Estimate for Doctor General Practitioner services in Sri Lanka Colombo. The signed copy shall serve as a binding agreement between the parties.
For Colombo General Practice Clinic
Dr. [Name], MBBS, MRCGP
Doctor General Practitioner
License No: SL-MED-2014-2231
Client / Patient
Name: _________________________
NIC / Passport No: _______________
Create your own Word template with our GoGPT AI prompt:
GoGPT