Quotation Estimate Ophthalmologist in China Shanghai –Free Word Template Download with AI
Professional Ophthalmologist Services — China Shanghai
Shanghai Vision Care & Ophthalmology Center, Pudong New Area, China Shanghai
Client Information| Client Name: | Mr. / Ms. [Full Name] |
| Address: | [Street Address], [District], China Shanghai, 200000, People's Republic of China |
| Contact Number: | +86 [Phone Number] |
| Email: | [Email Address] |
| Insurance Provider: | [Insurance Company Name / Self-Pay] |
This Quotation Estimate has been prepared by our qualified Ophthalmologist team at the Shanghai Vision Care & Ophthalmology Center, located in the heart of China Shanghai. The following line items represent the comprehensive ophthalmological services, diagnostic procedures, and therapeutic interventions proposed for the client. All pricing reflects the current 2025 fee schedule approved by the China Shanghai Municipal Health Commission.
| No. | Service / Procedure Description | Ophthalmologist Specialist | Qty | Unit Price (CNY) | Subtotal (CNY) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (including visual acuity, refraction, intraocular pressure, and slit-lamp biomicroscopy) | Dr. Wei Zhang, MD | 1 | ¥ 680.00 | ¥ 680.00 |
| 2 | Dilated Fundus Examination & Optical Coherence Tomography (OCT) of the Macula and Optic Nerve | Dr. Li Na, MD | 1 | ¥ 1,250.00 | ¥ 1,250.00 |
| 3 | Corneal Topography & Pachymetry (for contact lens fitting or pre-surgical assessment) | Dr. Chen Hao, MD | 1 | ¥ 880.00 | ¥ 880.00 |
| 4 | Anterior Segment & Wide-Field Fundus Photography (digital imaging, 45-degree field) | Dr. Li Na, MD | 1 | ¥ 520.00 | ¥ 520.00 |
| 5 | Visual Field Testing (Humphrey 24-2 Standard Threshold) — both eyes | Dr. Chen Hao, MD | 2 | ¥ 350.00 | ¥ 700.00 |
| 6 | Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implantation (per eye, including pre-op Ophthalmologist assessment, surgical fee, and post-op follow-up visits) | Dr. Wei Zhang, MD | 2 | ¥ 18,500.00 | ¥ 37,000.00 |
| 7 | Post-Operative Ophthalmologist Follow-Up Visits (Week 1, Week 4, and Month 3) — includes suture check, IOL position verification, and visual rehabilitation guidance | Dr. Wei Zhang, MD | 3 | ¥ 450.00 | ¥ 1,350.00 |
| 8 | Prescription Medications & Post-Operative Eye Drops (antibiotic, anti-inflammatory, and lubricating drops for 6 weeks) | Pharmacy, China Shanghai | 1 | ¥ 1,120.00 | ¥ 1,120.00 |
| 9 | Annual Ophthalmologist Health Screening Package (for family members, up to 4 individuals, including basic refraction, IOP, and fundus photo) | Dr. Li Na, MD | 4 | ¥ 420.00 | ¥ 1,680.00 |
| GRAND TOTAL (CNY) | ¥ 45,180.00 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiration date, the Ophthalmologist services and pricing listed herein may be subject to revision in accordance with the prevailing fee schedule in China Shanghai.
- All Ophthalmologist consultations and surgical procedures will be performed at the Shanghai Vision Care & Ophthalmology Center, No. 888 Century Avenue, Pudong New Area, China Shanghai, 200120. The client is responsible for arranging transportation to and from the facility.
- Payment is due within fourteen (14) days of the acceptance of this Quotation Estimate. A 50% deposit is required to confirm the surgical appointment with the Ophthalmologist. The remaining balance shall be settled prior to the commencement of the procedure.
- Accepted payment methods include bank transfer (CNY), UnionPay, Alipay, WeChat Pay, and major international credit cards (Visa, Mastercard). A 2% surcharge applies to international card transactions processed in China Shanghai.
- The Ophthalmologist team reserves the right to modify the surgical plan intraoperatively if unforeseen clinical conditions are encountered. Any additional procedures will be communicated to the client or their authorized representative prior to implementation, and a supplementary Quotation Estimate will be issued.
- Post-operative care, including the scheduled follow-up visits with the Ophthalmologist, is included in this Quotation Estimate. Emergency visits outside the scheduled follow-up window will be billed separately at the standard consultation rate in China Shanghai.
- This Quotation Estimate does not constitute a guarantee of specific visual outcomes. The Ophthalmologist will provide a thorough informed consent discussion prior to any surgical intervention, in compliance with the regulations of the National Health Commission of the People's Republic of China.
- All medical records, imaging data, and diagnostic reports generated during the course of treatment will be stored in accordance with China's Personal Information Protection Law (PIPL) and the China Shanghai data retention regulations. The client retains the right to access and request copies of their records at any time.
- Disputes arising from this Quotation Estimate shall be resolved through negotiation. In the event of unresolved disagreement, the matter shall be submitted to the Shanghai International Arbitration Center in China Shanghai for binding arbitration under its rules.
- This Quotation Estimate is prepared in English for the convenience of the client. In the event of any discrepancy between the English version and the Chinese-language version, the Chinese version shall prevail as the legally binding document under the laws of the People's Republic of China.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in China Shanghai and agrees to the terms and conditions outlined above. The Ophthalmologist team at Shanghai Vision Care & Ophthalmology Center will proceed with scheduling upon receipt of the signed document and the required deposit.
For the Client:
Signature & DateName: ___________________________
For the Ophthalmologist / Provider:
Dr. Wei Zhang, MD — Lead OphthalmologistShanghai Vision Care & Ophthalmology Center, China Shanghai
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