Quotation Estimate Ophthalmologist in India Mumbai –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — India Mumbai
Ref: QTE/OPH/MUM/2025/00472 | Valid Until: 30 June 2025
1. Purpose of This Quotation EstimateThis Quotation Estimate is issued by Vision Care Eye Institute, a premier Ophthalmologist practice located in India Mumbai, to provide a detailed and transparent breakdown of all anticipated costs associated with the proposed ophthalmic care plan. This document serves as a formal Quotation Estimate for the patient and their authorized representatives, outlining the scope of services, associated fees, and payment terms for the complete ophthalmological treatment package. All pricing in this Quotation Estimate is quoted in Indian Rupees (INR) and is subject to the terms and conditions stated herein.
2. Scope of Ophthalmologist ServicesThe undersigned Ophthalmologist, Dr. Ananya Deshmukh, along with the supporting clinical team at Vision Care Eye Institute in India Mumbai, proposes to deliver the following comprehensive ophthalmic services as detailed in this Quotation Estimate:
| S.No. | Service / Procedure | Description | Quantity | Unit Rate (INR) | Amount (INR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation | Initial and follow-up consultations with a senior Ophthalmologist in India Mumbai, including history, visual acuity testing, and clinical examination | 3 Sessions | ₹1,500 | ₹4,500 |
| 2 | Dilated Fundus Examination | Retinal and optic nerve assessment using mydriatic drops and direct/indirect ophthalmoscopy | 2 Sessions | ₹800 | ₹1,600 |
| 3 | Optical Coherence Tomography (OCT) | High-resolution cross-sectional imaging of the retina for diagnostic evaluation | 2 Scans | ₹1,200 | ₹2,400 |
| 4 | Anterior Segment Biometry & IOL Calculation | Measurement of axial length, corneal curvature, and intraocular lens power calculation for cataract surgery planning | 1 Session | ₹2,000 | ₹2,000 |
| 5 | Phacoemulsification Cataract Surgery (Monofocal IOL) | Complete surgical procedure performed by the Ophthalmologist, including pre-operative workup, surgery, and post-operative care for one eye | 1 Eye | ₹35,000 | ₹35,000 |
| 6 | Post-Operative Ophthalmologist Follow-Up Visits | Four scheduled follow-up visits with the Ophthalmologist in India Mumbai for wound healing assessment, IOP monitoring, and visual recovery tracking | 4 Visits | ₹1,000 | ₹4,000 |
| 7 | Prescription Medications (Post-Surgical) | Antibiotic eye drops, anti-inflammatory drops, and lubricants for 30 days post-surgery | 1 Set | ₹2,500 | ₹2,500 |
| 8 | Corneal Topography & Refraction | Computerized corneal mapping and precise refraction for spectacle or contact lens prescription | 1 Session | ₹1,000 | ₹1,000 |
| Subtotal | ₹53,000 | ||||
| GST @ 18% (as applicable in India Mumbai healthcare regulations) | ₹9,540 | ||||
| Grand Total (Quotation Estimate Amount) | ₹62,540 | ||||
3.1 Validity: This Quotation Estimate is valid for a period of thirty (30) days from the date of issue. Beyond this period, the Ophthalmologist and the institute reserve the right to revise the pricing due to changes in consumable costs, regulatory updates in India Mumbai, or availability of surgical slots.
3.2 Payment Schedule: A 50% advance payment (₹31,270) is required at the time of accepting this Quotation Estimate to confirm the surgical slot. The remaining 50% (₹31,270) shall be payable on the day of the surgical procedure or within 48 hours post-surgery, whichever is earlier.
3.3 Cancellation Policy: In the event the patient cancels the scheduled Ophthalmologist procedure, the advance payment is non-refundable if cancellation occurs less than 72 hours before the scheduled date. Cancellations made more than 72 hours in advance will be refunded after deducting a 10% administrative fee.
3.4 Scope Limitation: This Quotation Estimate covers only the services explicitly listed above. Any additional diagnostic tests, emergency interventions, or complications arising during or after the procedure that require further Ophthalmologist attention will be billed separately at the institute's standard rates in India Mumbai.
3.5 Insurance & Corporate Tie-ups: The patient is advised to verify coverage with their health insurance provider. Vision Care Eye Institute in India Mumbai accepts major insurance panels and corporate health schemes. The Ophthalmologist's office will assist in pre-authorization documentation.
3.6 Confidentiality: All medical records, diagnostic images, and personal data shared during the course of this Ophthalmologist engagement shall be treated with strict confidentiality in accordance with the Digital Personal Data Protection Act, 2023, and applicable Indian medical ethics guidelines.
3.7 Governing Law: This Quotation Estimate shall be governed by and construed in accordance with the laws of India. Any disputes shall be subject to the exclusive jurisdiction of the competent courts in Mumbai, Maharashtra, India.
4. Acceptance and AuthorizationBy signing below, the patient or authorized guardian acknowledges having received, read, and understood this Quotation Estimate for the Ophthalmologist services described herein. The patient confirms that the Ophthalmologist has explained the proposed treatment plan, potential risks, and alternative options in a manner that is comprehensible. The patient hereby authorizes Vision Care Eye Institute, India Mumbai, to proceed with the services upon receipt of the advance payment.
Patient / Authorized Guardian SignatureName: _________________________
Date: _________________________
Dr. Ananya Deshmukh, MD
Vision Care Eye Institute, India Mumbai
Date: _________________________
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