Quotation Estimate Ophthalmologist in France Paris –Free Word Template Download with AI
Ref. No: QTE-PAR-2025-04871 | Date of Issue: 14 June 2025 | Valid Until: 14 September 2025
Ophthalmologist Services — France Paris
Clinique Oculaire de la Rive Gauche
Dr. Émile Laurent, MD, PhD — Ophthalmologist
42 Boulevard Saint-Germain, 75005 Paris, France
+33 1 43 54 67 89
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English / French
This Quotation Estimate is issued by the above-named Ophthalmologist practice located in France Paris to provide the client with a comprehensive, itemised financial projection for the full spectrum of ophthalmological consultations, diagnostic examinations, and therapeutic procedures to be performed at our clinic situated in the 5th arrondissement of Paris, France. This document serves as a formal Quotation Estimate and does not constitute a binding contract until accepted in writing by the client. All pricing is expressed in Euros (EUR) and is subject to the current French healthcare reimbursement framework governed by the Assurance Maladie and applicable mutuelle supplementary insurance policies in France Paris.
The following Ophthalmologist services have been assessed and are included in this Quotation Estimate for the client's comprehensive eye care programme in France Paris:
| Item No. | Service Description | Frequency | Unit Price (EUR) | Quantity | Subtotal (EUR) |
|---|---|---|---|---|---|
| 01 | Initial Comprehensive Ophthalmologist Consultation & Visual Acuity Assessment (including refraction, intraocular pressure measurement, and slit-lamp biomicroscopy) | One-time | 120.00 | 1 | 120.00 |
| 02 | Dilated Fundus Examination with Optical Coherence Tomography (OCT) of the macula and optic nerve head | One-time | 95.00 | 1 | 95.00 |
| 03 | Anterior Segment OCT and Corneal Topography (Pentacam or equivalent) | One-time | 110.00 | 1 | 110.00 |
| 04 | Visual Field Perimetry (Humphrey 24-2 or 30-2) — bilateral | One-time | 85.00 | 1 | 85.00 |
| 05 | Fluorescein Fundus Photography & Wide-Field Retinal Imaging (45° or 200°) | One-time | 75.00 | 1 | 75.00 |
| 06 | Follow-up Ophthalmologist Consultation (subsequent visits, up to 4 sessions within 12 months) | Quarterly | 80.00 | 4 | 320.00 |
| 07 | Repeat OCT & Visual Field Monitoring (included in follow-up visits) | Quarterly | 60.00 | 4 | 240.00 |
| 08 | Prescription of Corrective Lenses (single-vision or progressive) — frame not included | One-time | 150.00 | 1 | 150.00 |
| 09 | Pharmacological Treatment (topical anti-glaucoma drops, anti-VEGF intravitreal injection if indicated, or dry-eye therapy) — estimated annual supply | Annual | 220.00 | 1 | 220.00 |
| 10 | Emergency Ophthalmologist Consultation (if required within the validity period, up to 2 visits) | As needed | 100.00 | 2 | 200.00 |
| Description | Amount (EUR) |
|---|---|
| Subtotal — All Ophthalmologist Services | 1,715.00 |
| French VAT (TVA) — 20% (where applicable; many medical consultations are exempt under Article 261 du CGI) | 0.00 |
| Estimated Assurance Maladie Reimbursement (base rate, 70% of the conventional tariff) | − 857.50 |
| Estimated Mutuelle Supplementary Reimbursement (typical 100% tier) | − 857.50 |
| Estimated Client Out-of-Pocket Cost (after insurance) | 0.00 |
| Total Quotation Estimate (before insurance reimbursement) | 1,715.00 |
The following terms govern this Quotation Estimate for Ophthalmologist services rendered in France Paris:
- Validity: This Quotation Estimate remains valid for a period of ninety (90) calendar days from the date of issue. After this period, pricing may be revised to reflect changes in French healthcare tariffs, pharmaceutical costs, or operational expenses of the Ophthalmologist practice.
- Acceptance: The client must sign and return a copy of this Quotation Estimate, or provide written electronic acceptance, before any Ophthalmologist service is scheduled. No service shall be rendered without a confirmed booking.
- Scheduling: Appointments for the Ophthalmologist consultations and diagnostic procedures will be coordinated by the clinic reception in Paris, France. The client will be notified of appointment dates, times, and any preparatory instructions (e.g., pupil dilation, fasting for certain tests) at least 48 hours in advance.
- Cancellation Policy: Cancellations must be made at least 24 hours prior to the scheduled appointment. Late cancellations or no-shows may incur a fee of 50% of the quoted session price.
- Medical Records: All diagnostic images, OCT scans, visual field charts, and consultation notes generated during the Ophthalmologist visits will be stored in the client's medical file in accordance with French data protection regulations (RGPD / GDPR). The client retains the right to access and request copies of these records at any time.
- Referrals: Should the Ophthalmologist determine that additional specialist intervention (e.g., vitreoretinal surgery, corneal transplant, or neuro-ophthalmology) is required, a separate Quotation Estimate will be issued prior to any further procedure.
- Payment: Payment is due at the time of each consultation or procedure. Accepted methods include bank card (CB), SEPA direct debit, and bank transfer. Invoicing will be provided in French and English to accommodate the client.
- Governing Law: This Quotation Estimate and all Ophthalmologist services rendered under it are governed by the laws of the French Republic. Any disputes shall be subject to the jurisdiction of the Tribunal Judiciaire de Paris, France.
| Role | Name | Signature | Date |
|---|---|---|---|
| Ophthalmologist / Provider | Dr. Émile Laurent, MD, PhD | _________________________ | ________________ |
| Client / Patient | _________________________ | _________________________ | ________________ |
By signing above, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in France Paris and agrees to the terms and conditions set forth herein. This document does not guarantee a specific medical outcome; all treatments are subject to the clinical judgement of the treating Ophthalmologist.
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