Quotation Estimate Ophthalmologist in Belgium Brussels –Free Word Template Download with AI

This Quotation Estimate is issued by Brussels Vision & Eye Care Centre, a licensed and accredited ophthalmology practice operating in the heart of Belgium Brussels, to provide a comprehensive and transparent breakdown of the professional Ophthalmologist services requested by the client. As a registered medical facility under the Belgian Federal Public Health Service and the Brussels-Capital Region health authority, our Ophthalmologist team is fully qualified to deliver diagnostic, therapeutic, and surgical eye care in accordance with Belgian medical regulations and EU healthcare standards.

The following Quotation Estimate covers a complete ophthalmological assessment and treatment plan tailored to the specific visual and ocular health needs of the client. All services are to be performed at our clinic located in the European Quarter of Brussels, Belgium, and are subject to the terms and conditions outlined in Section 5 of this document.

Note: In accordance with Belgian tax legislation (Code Général des Impôts), certain ophthalmologist diagnostic services may be partially reimbursed by the client's mutualité (health insurance fund). The RIMU codes listed above correspond to the Belgian medical procedure nomenclature for reimbursement purposes.

All ophthalmologist services described in this Quotation Estimate will be delivered by Dr. Catherine Moreau, MD, PhD, a board-certified ophthalmologist with over 18 years of clinical experience in cataract surgery, refractive procedures, and retinal diagnostics. Dr. Moreau is a registered member of the Belgian Ophthalmological Society (Société Belge d'Ophtalmologie) and the European Society of Cataract and Refractive Surgeons (ESCRS). The procedure will take place in our fully equipped surgical suite in Brussels, Belgium, which meets all Belgian hospital accreditation standards set by the Belgian Accreditation Agency (BAA).

This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Payment for the ophthalmologist surgical package (Ref. 05) is due as follows: a non-refundable deposit of 30% (€ 1,470.00) is required to confirm the surgical booking, and the remaining balance is payable within fourteen (14) days following the completion of the final post-operative ophthalmologist consultation. Diagnostic and consultation fees (Refs. 01–04, 06–08) are payable at the time of service. Accepted payment methods include bank transfer (IBAN: BE68 5390 0754 7034), credit card (Visa, Mastercard), and direct debit. A 1.5% late-payment interest fee per month applies to overdue balances in accordance with Belgian commercial law.

• This Quotation Estimate is a non-binding offer and does not constitute a contractual obligation until formally accepted in writing by the client and countersigned by our ophthalmologist practice manager.
• All ophthalmologist services are subject to a pre-operative medical clearance. The ophthalmologist reserves the right to reschedule or modify the treatment plan if the client's medical condition changes.
• Prices are quoted in Euro (EUR) and include all applicable Belgian taxes. No additional travel, parking, or administrative fees will be charged to the client.
• In the event of surgical complications, the ophthalmologist and the Brussels Vision & Eye Care Centre carry full professional medical liability insurance (€ 5,000,000 coverage) with AXA Belgium, policy no. AXA-BE-2025-77812.
• Client medical data is processed in strict compliance with the Belgian Privacy Act (Loi du 30 juillet 2018) and the EU General Data Protection Regulation (GDPR). Data is stored on servers located within Belgium.
• Any disputes arising from this Quotation Estimate or the subsequent ophthalmologist services shall be resolved under the jurisdiction of the Courts of Brussels, Belgium.
• Cancellation of a scheduled ophthalmologist surgical procedure more than 14 days in advance incurs no charge. Cancellation within 14 days forfeits the 30% deposit.

By signing below, the client acknowledges receipt of this Quotation Estimate for ophthalmologist services in Brussels, Belgium, and agrees to the terms and conditions set forth herein. This document, once signed by both parties, constitutes a binding service agreement for the ophthalmologist care described above.