Quotation Estimate Ophthalmologist in Brazil São Paulo –Free Word Template Download with AI
Ophthalmologist Professional Services — Brazil São Paulo
CONFIDENTIAL
1. Provider Information| Practice Name: | Clínica Ocular Paulista — Ophthalmologist Center |
| Address: | Av. Paulista, 1578 — Bela Vista, São Paulo, SP — CEP 01310-300, Brazil |
| CNPJ: | 12.345.678/0001-90 |
| Lead Ophthalmologist: | Dr. Ricardo Almeida, CRM-SP 123.456 |
| Contact: | +55 (11) 3456-7890 | [email protected] |
| Client Name: | Empresa de Saúde Integrada Ltda. |
| CNPJ: | 98.765.432/0001-10 |
| Address: | Rua Oscar Freire, 890 — Jardins, São Paulo, SP — CEP 01426-001, Brazil |
| Authorized Representative: | Sra. Mariana Costa — HR Director |
This Quotation Estimate is issued by Clínica Ocular Paulista, a specialized Ophthalmologist practice located in the heart of Brazil São Paulo, to provide a comprehensive range of ophthalmic diagnostic, therapeutic, and surgical services. The following itemized breakdown reflects the full scope of Ophthalmologist care to be delivered over a twelve-month contractual period, serving approximately 1,200 employees of the client organization.
4. Itemized Cost Breakdown| # | Service Description | Frequency / Qty | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation (initial and follow-up), including visual acuity testing, refraction, and slit-lamp examination | 1,200 sessions | R$ 350,00 | R$ 420,000,00 |
| 02 | Dilated Fundus Examination with OCT (Optical Coherence Tomography) performed by the Ophthalmologist team | 800 sessions | R$ 480,00 | R$ 384,000,00 |
| 03 | Glaucoma Screening Package (tonometry, perimetry, and optic nerve assessment) by the Ophthalmologist | 600 sessions | R$ 420,00 | R$ 252,000,00 |
| 04 | Cataract Surgical Procedure (phacoemulsification with intraocular lens implantation) performed by the senior Ophthalmologist | 45 procedures | R$ 8,500,00 | R$ 382,500,00 |
| 05 | Retinal Laser Photocoagulation and Anti-VEGF Intravitreal Injections administered under Ophthalmologist supervision | 120 sessions | R$ 2,800,00 | R$ 336,000,00 |
| 06 | Corneal Topography and Contact Lens Fitting by the Ophthalmologist and optometric team | 300 sessions | R$ 280,00 | R$ 84,000,00 |
| 07 | Annual Ophthalmologist Health Screening Program for all employees (group visit in Brazil São Paulo facility) | 1 event | R$ 150,000,00 | R$ 150,000,00 |
| 08 | Emergency Ophthalmologist On-Call Coverage (24/7) for urgent ocular conditions | 12 months | R$ 12,000,00 | R$ 144,000,00 |
| 09 | Administrative Coordination, Medical Records Management, and Billing Support for the Ophthalmologist program | 12 months | R$ 8,500,00 | R$ 102,000,00 |
| TOTAL ESTIMATED COST (BRL) | R$ 2,254,500,00 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on market conditions in Brazil São Paulo.
- All Ophthalmologist services will be performed at the Clínica Ocular Paulista facility in São Paulo, SP, or at the client's designated premises within the city of São Paulo, as mutually agreed upon.
- Payment terms: 50% upon contract signing and 50% upon completion of the twelve-month service period. Invoices will be issued in Brazilian Reais (BRL) and are payable within fifteen (15) business days via bank transfer (TED/DOC).
- The Ophthalmologist team is fully accredited by the Conselho Regional de Medicina do Estado de São Paulo (CREMESP) and complies with all ANVISA and CFM regulatory standards.
- Any additional Ophthalmologist procedures not listed in this Quotation Estimate will be subject to a separate written authorization and supplementary quotation.
- Cancellation or early termination of the contract requires sixty (60) days written notice. Services already rendered up to the termination date remain payable in full.
- This Quotation Estimate does not constitute a binding contract. A formal service agreement must be executed by both parties prior to the commencement of any Ophthalmologist services.
- All patient data and medical records are handled in strict compliance with the Brazilian General Data Protection Law (LGPD — Lei nº 13.709/2018).
By signing below, both parties acknowledge that this Quotation Estimate for Ophthalmologist services in Brazil São Paulo has been reviewed, understood, and accepted as a basis for the subsequent formal service agreement.
For Clínica Ocular Paulista
Dr. Ricardo AlmeidaLead Ophthalmologist — CRM-SP 123.456
Date: _______________
For Empresa de Saúde Integrada Ltda.
Sra. Mariana CostaHR Director
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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