Quotation Estimate Ophthalmologist in Algeria Algiers –Free Word Template Download with AI
Professional Ophthalmologist Services — Algeria Algiers
Document Ref: QE-OPH-2025-0847Issued By
Clinique Ophthalmologique d'Alger
42, Boulevard Zighout Youcef
Hydra, 16000 Algiers, Algeria
Tel: +213 (0) 23 45 67 89
Email: [email protected]
RC: 16B-0012345678
Quotation Details
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Prepared For: Mr. Karim Benali
Client Address: 18, Rue Didouche Mourad
Bab El Oued, 13000 Algiers, Algeria
Client Phone: +213 (0) 550 12 34 56
This Quotation Estimate is formally issued by Clinique Ophthalmologique d'Alger, a licensed and accredited medical facility located in the heart of Algeria Algiers, to provide Mr. Karim Benali with a comprehensive and transparent breakdown of all anticipated costs associated with a full ophthalmological evaluation and subsequent treatment plan. Our team of board-certified Ophthalmologist specialists in Algiers is committed to delivering world-class eye care while ensuring complete financial clarity for every patient. This document serves as a non-binding estimate and does not constitute a final invoice. All figures are presented in Algerian Dinars (DZD) and are subject to revision based on the findings of the initial clinical examination.
The following services have been requested and are covered under this Quotation Estimate. Each procedure will be performed by a senior Ophthalmologist or a qualified ophthalmic assistant under direct supervision, in accordance with the medical standards established by the Algerian Ministry of Health and the professional guidelines of the Algerian Ophthalmological Society.
| # | Service / Procedure Description | Quantity | Unit Price (DZD) | Subtotal (DZD) |
|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (visual acuity, refraction, intraocular pressure, slit-lamp biomicroscopy) | 1 session | 8,500 | 8,500 |
| 2 | Dilated Fundus Examination with Optical Coherence Tomography (OCT) of the retina and optic nerve | 1 session | 12,000 | 12,000 |
| 3 | Corneal Topography & Pachymetry (for refractive surgery assessment) | 1 session | 9,500 | 9,500 |
| 4 | Anterior Segment Ultrasound (B-Scan) & Biometry for IOL calculation | 1 session | 7,000 | 7,000 |
| 5 | Cataract Surgery (Phacoemulsification with Premium IOL implantation) — per eye | 2 eyes | 85,000 | 170,000 |
| 6 | Post-operative Ophthalmologist Follow-up Visits (weeks 1, 2, 4, and 8) | 4 visits | 4,000 | 16,000 |
| 7 | Prescribed Medications (antibiotic drops, anti-inflammatory drops, lubricant drops) — 30-day supply | 1 lot | 6,500 | 6,500 |
| 8 | Protective Eyewear & Post-operative Eye Shield | 1 set | 3,500 | 3,500 |
| 9 | Emergency Ophthalmologist Consultation (if required within 30 days post-surgery) | 1 visit | 5,000 | 5,000 |
| TOTAL ESTIMATED COST (DZD) | 238,000 | |||
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, all prices may be adjusted to reflect changes in medical supply costs, pharmaceutical pricing, or regulatory updates within Algeria Algiers.
- Payment Schedule: A deposit of 40% (95,200 DZD) is required at the time of scheduling the surgical procedure. The remaining 60% (142,800 DZD) is due within seven (7) business days following the completion of the final post-operative visit. Payment may be made via bank transfer to the clinic's account at CNEP Bank, Algiers branch, or by certified cheque.
- Insurance & CNAS: The patient is advised to verify coverage with the Caisse Nationale des Assurances Sociales (CNAS) or their private health insurer. Our Ophthalmologist team in Algiers can provide the necessary medical documentation and pre-authorization forms to facilitate reimbursement claims.
- Scope Limitations: This estimate covers the procedures listed above. Any additional diagnostic tests, complications, or secondary interventions identified during the course of treatment will be communicated to the patient in writing prior to execution, and a supplementary Quotation Estimate will be issued.
- Medical Disclaimer: The final treatment plan is subject to the clinical judgment of the attending Ophthalmologist. In the event that the examination reveals conditions not anticipated at the time of this estimate (e.g., glaucoma, diabetic retinopathy, or corneal dystrophy), the scope of work and associated costs will be revised accordingly.
- Confidentiality: All patient data and medical records are handled in strict compliance with Algerian data protection regulations and the professional code of ethics of the Algerian Medical Council.
- Dispute Resolution: Any disagreement regarding the services rendered or the costs outlined in this Quotation Estimate shall be resolved amicably between the parties. In the absence of a mutual agreement, the matter shall be referred to the competent medical tribunal in Algiers, Algeria.
By signing below, the patient acknowledges receipt of this Quotation Estimate and confirms understanding of the proposed Ophthalmologist services, the associated costs, and the terms outlined herein. This signature does not obligate the patient to proceed with the treatment but serves as a formal record of the estimate provided by our clinic in Algeria Algiers.
For Clinique Ophthalmologique d'Alger
Dr. Amina Cherif, MD, PhD
Lead Ophthalmologist & Director
Patient / Authorized Representative
Mr. Karim Benali
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