Quotation Estimate Ophthalmologist in Brazil Brasília –Free Word Template Download with AI

This Quotation Estimate is issued by Clínica Ocular Brasília – Centro de Excelência em Oftalmologia, a licensed and accredited ophthalmology practice located at Setor Médico-Hospitalar Sul (SMHS), Quadra 01, Bloco A, Sala 412, Asa Sul, Brasília – DF, CEP 70305-900, Brazil Brasília. The clinic operates under CNPJ 12.345.678/0001-90 and is registered with the Conselho Regional de Medicina do Distrito Federal (CRM-DF). All services described in this Quotation Estimate are delivered by a board-certified Ophthalmologist with over fifteen years of clinical experience in comprehensive eye care, surgical procedures, and advanced diagnostic imaging.

This Quotation Estimate is prepared for the requesting party identified below. All pricing, service descriptions, and terms contained herein are specific to this client engagement and are valid exclusively for the period stated in the document header.

The following itemized services constitute the complete scope of work covered by this Quotation Estimate. Each service is performed or supervised by a qualified Ophthalmologist at our Brasília facility. The Quotation Estimate includes all diagnostic consultations, therapeutic interventions, and post-procedure follow-up visits as detailed below.

• This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, all prices are subject to revision based on current market conditions in Brazil Brasília.
• All Ophthalmologist services are subject to prior medical evaluation. The attending Ophthalmologist reserves the right to modify the treatment plan if clinical findings warrant additional or alternative procedures. Any such modifications will be communicated in writing and require client authorization before proceeding.
• Payment terms: 50% (fifty percent) of the total Quotation Estimate value is due upon acceptance of this document. The remaining 50% (fifty percent) is due within fifteen (15) business days following the completion of the primary surgical procedure. Payment may be made via bank transfer (TED/PIX) to the account details provided by Clínica Ocular Brasília.
• This Quotation Estimate does not include hospitalization fees, anesthesia costs exceeding standard local anesthesia, or emergency interventions not anticipated in the initial clinical assessment. Such additional costs will be itemized in a supplementary Quotation Estimate prior to any extra procedure.
• All Ophthalmologist services are performed in compliance with the regulations of the Conselho Federal de Medicina (CFM) and the specific guidelines of the CRM-DF. The clinic maintains full malpractice insurance coverage for all procedures listed in this Quotation Estimate.
• Client data and medical records are handled in strict accordance with the Brazilian General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Lei nº 13.709/2018). No information will be shared with third parties without explicit written consent.
• This Quotation Estimate is non-transferable and applies exclusively to the client identified in Section 2. It does not constitute a binding contract until formally accepted in writing by both parties.

By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Brazil Brasília, accepts the pricing and terms outlined herein, and authorizes Clínica Ocular Brasília to proceed with the scheduled services. The Ophthalmologist and the clinic team confirm that all services will be delivered with the highest standard of clinical care and professional ethics.