Quotation Estimate Ophthalmologist in Iran Tehran –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — Iran Tehran
Vision Care Medical Center | Tehran, Iran
1. Client Information| Client Name: | Mr. / Ms. [Full Name] |
| National ID (Code Melli): | [000-000-0000] |
| Address: | [Street, District], Tehran, Iran |
| Contact Number: | +98 [XX] XXX XXXX |
| Email: | [[email protected]] |
This Quotation Estimate is issued by Vision Care Medical Center, a licensed ophthalmology practice located in the heart of Iran Tehran, to provide a detailed financial breakdown of the proposed Ophthalmologist consultation, diagnostic, and treatment services. The following services have been recommended following the initial screening examination conducted at our Tehran clinic. All procedures will be performed by a board-certified Ophthalmologist with over fifteen years of clinical experience in the Tehran metropolitan area.
3. Itemized Cost Breakdown| Item No. | Service Description | Quantity | Unit Price (IRR) | Total (IRR) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & Eye Examination (including visual acuity, refraction, and slit-lamp biomicroscopy) | 1 session | 2,500,000 | 2,500,000 |
| 02 | Dilated Fundus Examination by Ophthalmologist (mydriatic drops and retinal assessment) | 1 session | 1,800,000 | 1,800,000 |
| 03 | Optical Coherence Tomography (OCT) — Macular & Retinal Nerve Fiber Layer Analysis | 2 scans | 1,200,000 | 2,400,000 |
| 04 | Intraocular Pressure Measurement (Tonometry) — Glaucoma Screening | 1 session | 800,000 | 800,000 |
| 05 | Corneal Topography & Pachymetry (for refractive surgery evaluation) | 1 session | 1,500,000 | 1,500,000 |
| 06 | Prescription of Corrective Lenses (single-vision or progressive) — Ophthalmologist-verified | 1 pair | 4,500,000 | 4,500,000 |
| 07 | Follow-up Ophthalmologist Visit (4 weeks post-treatment, Tehran clinic) | 1 session | 1,500,000 | 1,500,000 |
| 08 | Pharmacological Treatment (topical eye drops, 3-month supply as prescribed by Ophthalmologist) | 1 course | 2,200,000 | 2,200,000 |
| Subtotal (IRR) | 17,200,000 | |||
| VAT (9% — Iranian Tax Authority) | 1,548,000 | |||
| GRAND TOTAL (IRR) | 18,748,000 | |||
- A deposit of 30% of the total Quotation Estimate amount (IRR 5,624,400) is due upon acceptance of this document to reserve the Ophthalmologist's appointment slot in Tehran.
- The remaining 70% balance (IRR 13,123,600) shall be settled in full prior to the commencement of any invasive or surgical procedure.
- Accepted payment methods: Bank transfer (Shetab / IRT), cash at the Tehran clinic reception, or approved Iranian credit cards (Shetab network).
- All prices are quoted in Iranian Rials (IRR) and are subject to the prevailing exchange rate if the client requests payment in foreign currency (USD, EUR, or AED).
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Ophthalmologist's fees and material costs may be revised in accordance with the current pricing schedule of the Tehran Medical Association.
- All diagnostic and treatment services will be performed at our licensed facility located in Tehran, Iran, in full compliance with the regulations set forth by the Iranian Ministry of Health and Medical Education.
- The treating Ophthalmologist reserves the right to modify the treatment plan based on clinical findings during the examination. Any additional procedures not listed in this Quotation Estimate will be communicated to the client in writing before execution, with a supplementary estimate provided.
- Cancellation policy: Cancellations made more than 72 hours before the scheduled appointment will receive a full refund of the deposit. Cancellations within 72 hours will forfeit 50% of the deposit. No-shows will forfeit the entire deposit.
- Medical records and diagnostic imaging (OCT scans, fundus photographs, topography maps) will be retained at the Tehran clinic for a minimum of ten (10) years in accordance with Iranian medical record-keeping law.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. The Ophthalmologist will exercise the highest standard of care consistent with accepted ophthalmic practice in Iran.
- In the event of a dispute, all matters shall be governed by the civil and commercial laws of the Islamic Republic of Iran, and jurisdiction shall lie with the competent courts of Tehran.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Iran Tehran, agrees to the terms and conditions outlined herein, and authorizes the Vision Care Medical Center to proceed with the recommended care plan.
Client SignatureName: _________________________
Date: _________________________ Ophthalmologist / Authorized Representative
Dr. Amir Hosseini, MD
Vision Care Medical Center, Tehran, Iran
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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