Quotation Estimate Ophthalmologist in Israel Tel Aviv –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — Tel Aviv, Israel
Document Ref: QTE-TLV-2025-0847| Quotation Date | 15 June 2025 | Validity Period | 30 days from issue date |
| Prepared By | Dr. Miriam Levi, MD, FACS — Ophthalmologist | Clinic Address | 42 Dizengoff Street, Tel Aviv-Yafo, Israel 64971 |
| Client Name | [Client / Patient Name] | Client ID / File No. | TLV-OPH-2025-3391 |
| Contact Phone | +972-3-517-XXXX | [email protected] |
This Quotation Estimate is issued by the Ophthalmologist practice located in Tel Aviv, Israel, to provide the client with a detailed, itemized financial projection for the full scope of ophthalmological care, diagnostic procedures, and therapeutic interventions to be performed at our clinic on Dizengoff Street. 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 presented in New Israeli Shekels (ILS / NIS) and reflects the current fee schedule of our Ophthalmologist team as approved by the Israeli Ministry of Health and the local Tel Aviv-Yafo Municipal Health Authority.
The following Quotation Estimate covers a comprehensive package of Ophthalmologist services tailored to the client's specific ocular health needs. Each procedure listed below has been recommended by our senior Ophthalmologist following an initial consultation conducted in Tel Aviv. The services include diagnostic imaging, surgical intervention where applicable, post-operative follow-up, and prescription of corrective lenses or pharmaceutical treatments.
| # | Ophthalmologist Service / Procedure | Quantity | Unit Price (ILS) | Subtotal (ILS) |
|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (including visual acuity, intraocular pressure, and slit-lamp biomicroscopy) | 1 session | 450.00 | 450.00 |
| 2 | Dilated Fundus Examination & Optical Coherence Tomography (OCT) of the Macula | 1 session | 620.00 | 620.00 |
| 3 | Corneal Topography & Pachymetry (for Ophthalmologist assessment of corneal curvature and thickness) | 1 session | 380.00 | 380.00 |
| 4 | Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implantation (performed by the Ophthalmologist in a Tel Aviv accredited surgical suite) | 1 eye | 8,500.00 | 8,500.00 |
| 5 | Post-Operative Ophthalmologist Follow-Up Visits (including wound check, IOP measurement, and visual rehabilitation assessment) | 4 visits | 250.00 | 1,000.00 |
| 6 | Prescription of Post-Surgical Ophthalmic Medications (antibiotic drops, anti-inflammatory drops, lubricating drops) — 30-day supply | 1 package | 320.00 | 320.00 |
| 7 | Custom-Fitted Reading Glasses / Bifocal Dispensing (if required post-surgery, as determined by the Ophthalmologist) | 1 pair | 750.00 | 750.00 |
| 8 | Annual Ophthalmologist Preventive Eye Screening (subsequent year, in Tel Aviv clinic) | 1 session | 350.00 | 350.00 |
| Subtotal (before VAT) | 12,370.00 | |||
| VAT @ 18% (Israel) | 2,226.60 | |||
| TOTAL ESTIMATED COST (ILS) | 14,596.60 | |||
3.1 This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, the Ophthalmologist practice in Tel Aviv reserves the right to revise pricing due to changes in medical supply costs, pharmaceutical pricing, or regulatory adjustments by the Israeli health authorities.
3.2 The total amount stated in this Quotation Estimate is an estimate based on the current clinical assessment. Should the Ophthalmologist, during the course of treatment, identify additional conditions requiring intervention (e.g., concurrent glaucoma, diabetic retinopathy, or retinal detachment), a supplemental Quotation Estimate will be issued and must be approved by the client before any additional procedures are performed.
3.3 Payment terms: A deposit of 30% of the total Quotation Estimate amount is due upon acceptance. The remaining 70% is payable within fourteen (14) days following the completion of all Ophthalmologist services. Payment may be made via bank transfer to the clinic's account in Tel Aviv, by credit card, or through approved Israeli health insurance reimbursement (Bituach Leumi / supplementary private insurance).
3.4 All Ophthalmologist procedures listed in this Quotation Estimate will be performed in accordance with the standards set by the Israeli Medical Association, the Tel Aviv-Yafo District Health Department, and the relevant EU medical device regulations applicable in Israel.
3.5 The client acknowledges that this Quotation Estimate does not guarantee specific medical outcomes. The Ophthalmologist will exercise the highest standard of clinical care, but individual patient responses to treatment may vary.
3.6 Cancellation policy: Should the client cancel the scheduled Ophthalmologist appointment with less than 72 hours' notice, a cancellation fee of 20% of the applicable service fee will be charged as stated in this Quotation Estimate.
Note: This Quotation Estimate has been prepared specifically for the Tel Aviv, Israel location of our Ophthalmologist practice. All services, diagnostics, and surgical procedures referenced herein are to be conducted at our Dizengoff Street clinic. The Ophthalmologist team is licensed by the Israeli Medical Licensing Authority and maintains full malpractice insurance coverage as required by Israeli law.By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Tel Aviv, Israel, and authorizes the Ophthalmologist practice to proceed with the outlined scope of care subject to the terms and conditions stated above.
Client Signature & Date
Dr. Miriam Levi, MD — Ophthalmologist
Tel Aviv, Israel
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