Quotation Estimate Ophthalmologist in France Lyon –Free Word Template Download with AI
12 Rue de la République, 69002 Lyon, France
Tel: +33 4 72 00 00 00 | Email: [email protected]
SIRET: 842 567 890 00012 | ADELI: 6910000000000
Accrédité HAS – Haute Autorité de Santé Quotation EstimateQuotation Details
Quotation No.: QE-2025-04872
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Currency: EUR (€)
Client Information
Name: M. Jean-Pierre Moreau
Address: 45 Avenue Jean Jaurès, 69007 Lyon, France
Insurance: CPAM 69 – N° 1 85 04 69 123 456 78
Complementary: MGEN – N° 69012345678
This Quotation Estimate is issued by the Ophthalmologist team at Clinique Ophthalmologique de Lyon, a specialized ophthalmology practice located in the heart of France Lyon. The following document outlines the estimated costs for the comprehensive ophthalmological care and procedures recommended for the patient listed above. All prices are expressed in Euros (€) and are subject to the standard reimbursement rates set by the French national health insurance system (Assurance Maladie) and applicable complementary insurance (mutuelle) policies in the Lyon metropolitan area.
| Ref | Service / Procedure | Description | Quantity | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 01 | Comprehensive Ophthalmological Consultation | Initial assessment by the Ophthalmologist, visual acuity testing, slit-lamp examination, and intraocular pressure measurement | 1 | € 70.00 | € 70.00 |
| 02 | Dilated Fundus Examination | Mydriatic eye examination with retinal imaging to assess the health of the retina, optic nerve, and macula | 1 | € 45.00 | € 45.00 |
| 03 | Optical Coherence Tomography (OCT) | High-resolution cross-sectional imaging of the retina performed by the Ophthalmologist to detect early signs of macular degeneration or glaucoma | 2 | € 55.00 | € 110.00 |
| 04 | Visual Field Perimetry (Humphrey) | Automated perimetry to map the peripheral vision, essential for glaucoma monitoring in the Lyon region | 1 | € 60.00 | € 60.00 |
| 05 | Corneal Topography (Pentacam) | Anterior segment analysis including corneal thickness, curvature mapping, and anterior chamber depth measurement | 1 | € 85.00 | € 85.00 |
| 06 | Phacoemulsification Cataract Surgery (per eye) | Microsurgical removal of the cataractous lens and implantation of a premium multifocal intraocular lens, performed by the senior Ophthalmologist in our Lyon operating theatre | 2 | € 1,850.00 | € 3,700.00 |
| 07 | Post-Operative Follow-Up Visits | Three scheduled post-operative consultations by the Ophthalmologist at 1 day, 1 week, and 1 month intervals to monitor healing in France Lyon | 3 | € 50.00 | € 150.00 |
| 08 | Prescription of Post-Operative Medications | Antibiotic and anti-inflammatory eye drops for 30 days, dispensed at our in-clinic pharmacy in Lyon | 1 | € 38.00 | € 38.00 |
| 09 | Annual Ophthalmological Screening (Year 2) | Preventive check-up including visual acuity, tonometry, and fundus photography to be conducted at our practice in France Lyon | 1 | € 95.00 | € 95.00 |
| TOTAL ESTIMATED AMOUNT (TTC) | € 4,353.00 | ||||
| Estimated CPAM Reimbursement (70% of base rate) | – € 1,248.00 | ||||
| Estimated MGEN Complementary Reimbursement | – € 890.00 | ||||
| PATIENT OUT-OF-POCKET ESTIMATE | € 2,215.00 | ||||
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for a period of thirty (30) days from the date of issue. After this period, the Ophthalmologist reserves the right to revise the pricing due to changes in medical supply costs or updated French national health regulations applicable in France Lyon.
- All surgical procedures listed in this Quotation Estimate will be performed by a board-certified Ophthalmologist registered with the Ordre des Médecins in the Rhône department (69), Lyon, France. The patient will receive a pre-operative consultation to review the surgical plan, risks, and expected outcomes.
- The estimated reimbursement amounts are based on the current tariff grid (Nomenclature des actes médicaux) published by the Assurance Maladie for the Lyon region. Actual reimbursement may vary depending on the specific terms of the patient's complementary insurance contract (mutuelle) and any applicable franchise or ticket modérateur.
- Payment for the full estimated amount is due within fifteen (15) business days of the date of this Quotation Estimate. The patient may request a split payment plan by contacting our billing office at the Lyon clinic. A 1.5% monthly late-payment interest rate will apply to overdue balances in accordance with French commercial law.
- In the event of unforeseen intra-operative complications, the Ophthalmologist will inform the patient or their designated family member immediately. Any additional procedures required to address such complications will be subject to a separate Quotation Estimate or, in emergency cases, to the patient's prior written consent on file.
- This Quotation Estimate does not constitute a binding contract for medical services. It serves solely as a financial projection. The final invoice may differ by up to 10% depending on the complexity encountered during the actual procedures performed in our Lyon facility.
- All medical records, imaging data, and surgical reports generated during the course of treatment will be stored in accordance with the French Data Protection Act (Loi Informatique et Libertés) and the GDPR. The patient retains the right to access their full ophthalmological file at any time by contacting the Ophthalmologist's office in France Lyon.
- For any questions, clarifications, or modifications to this Quotation Estimate, please contact our patient relations department at +33 4 72 00 00 01 or by email at [email protected]. Our team is available Monday through Friday, 8:00 AM to 5:30 PM, at our clinic located in the 2nd arrondissement of Lyon, France.
For the Ophthalmologist / Clinique Ophthalmologique de Lyon
Dr. Claire Fontaine, MD, PhD
Chief Ophthalmologist
Signature & Stamp:
Accepted by the Patient
M. Jean-Pierre Moreau
Date: _______________
Signature:
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