Quotation Estimate Ophthalmologist in Colombia Medellín –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — Colombia, Medellín
Provider Information
Medellín Vision Care Center
Ophthalmologist & Eye Care Specialists
Calle 43 # 43A-15, El Poblado
Medellín, Antioquia, Colombia
NIT: 901.234.567-8
Phone: +57 (604) 444 5566
Email: [email protected]
Client Information
Client Name: [Full Name]
Document No.: [Cédula / Passport]
Address: [Street, Neighborhood]
City: Medellín, Colombia
Phone: [Contact Number]
Email: [Email Address]
Quotation Estimate No.: QTE-MED-2025-00487
Date of Issue: June 15, 2025
Valid Until: July 15, 2025 (30 days)
Service Location: Medellín, Antioquia, Colombia
Specialty: Ophthalmologist — General & Surgical
Currency: Colombian Peso (COP)
This Quotation Estimate is issued by Medellín Vision Care Center, a certified ophthalmology practice located in the heart of Colombia Medellín, to provide a detailed and transparent breakdown of all ophthalmological services requested by the client. Our team of board-certified Ophthalmologist professionals in Medellín, Colombia, is committed to delivering world-class eye care using state-of-the-art diagnostic and surgical equipment. The following services have been evaluated based on the initial consultation conducted on June 10, 2025, and reflect the current fee schedule of our clinic in Medellín, Antioquia.
| No. | Service Description | Quantity | Unit Price (COP) | Subtotal (COP) |
|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Visual Acuity Assessment | 1 session | $185,000 | $185,000 |
| 2 | Dilated Fundus Examination & Retinal Imaging (OCT Scan) | 1 session | $220,000 | $220,000 |
| 3 | Corneal Topography & Pachymetry Analysis | 1 session | $195,000 | $195,000 |
| 4 | Intraocular Pressure Measurement (Tonometry) & Glaucoma Screening | 2 sessions | $95,000 | $190,000 |
| 5 | Phacoemulsification Cataract Surgery (per eye) with Premium IOL Implant | 2 eyes | $2,850,000 | $5,700,000 |
| 6 | Post-Surgical Ophthalmologist Follow-Up Visits (Week 1, Week 4, Month 3) | 3 visits | $120,000 | $360,000 |
| 7 | Prescription Medications & Post-Operative Eye Drops (30-day supply) | 1 package | $145,000 | $145,000 |
| 8 | Custom Prescription Eyeglass Lenses (Progressive Bifocal) & Frame | 1 pair | $480,000 | $480,000 |
| 9 | Emergency Ophthalmologist On-Call Coverage (12-month plan, Medellín area) | 1 year | $350,000 | $350,000 |
| TOTAL ESTIMATED COST (COP): | $7,825,000 | |||
| TOTAL ESTIMATED COST (USD, approx. at 3,900 COP/USD): | $2,006.41 | |||
The Ophthalmologist services outlined in this Quotation Estimate will be performed by Dr. [Name], a board-certified ophthalmologist registered with the Colombian Medical Association (Asociación Médica Colombiana) and the Antioquia Departmental Medical Board. The practice in Medellín, Colombia, holds a valid operating license from the Secretaría de Salud de Antioquia and complies with all regulations set forth by the Superintendencia Nacional de Salud. All surgical procedures are conducted in an accredited surgical suite within our clinic located in the El Poblado district of Medellín, ensuring the highest standards of patient safety and clinical excellence.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision based on changes in medical supply costs, exchange rates, or regulatory adjustments in Colombia.
- The Ophthalmologist services described herein are contingent upon the client's medical eligibility as determined by the pre-operative evaluation. Should additional procedures be identified during the initial assessment, a supplementary Quotation Estimate will be issued prior to any additional treatment.
- Payment terms: A 50% deposit is required to schedule the surgical procedure. The remaining 50% balance is due within seven (7) business days following the completion of the final post-operative visit. Accepted payment methods include bank transfer (Bancolombia, Davivienda, BBVA Colombia), credit/debit card, and cash at our Medellín office.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Ophthalmologist will exercise the highest standard of care in accordance with the ethical and clinical guidelines of the Colombian ophthalmology community.
- Any cancellation of scheduled procedures by the client more than 72 hours in advance will result in a 10% administrative fee. Cancellations within 72 hours or no-shows will forfeit the full deposit.
- All medical records, diagnostic imaging, and surgical reports generated during the course of treatment will be stored in compliance with Colombia's Data Protection Law (Ley 1581 de 2012) and the patient's right to privacy.
- This Quotation Estimate is non-transferable and is issued exclusively for the client named in this document. Any changes to the scope of services require written authorization from both parties.
- Disputes arising from this Quotation Estimate or the services rendered shall be resolved in accordance with the civil and commercial laws of the Republic of Colombia, with jurisdiction in the courts of Medellín, Antioquia.
By signing below, the client acknowledges that they have received, reviewed, and understood this Quotation Estimate for Ophthalmologist services to be provided in Colombia, Medellín. The client authorizes Medellín Vision Care Center to proceed with the services as described, subject to the terms and conditions outlined above.
Client Signature
Name: ______________________________Date: ______________________________
Ophthalmologist / Authorized Representative
Name: ______________________________R.M. No.: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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