Quotation Estimate Ophthalmologist in Italy Milan –Free Word Template Download with AI
Ophthalmologist Professional Services
Milan, Italy – Lombardy Region
Service Provider
Clinica Oculistica Milano
Via Paolo Sarpi, 21
20154 Milan (MI), Italy
Tel: +39 02 4567 8901
Email: [email protected]
VAT (P.IVA): IT01234567890
Client / Patient
Dr. Alessandro Bianchi
Via Torino, 45
20123 Milan (MI), Italy
Tel: +39 333 123 4567
Email: [email protected]
SSN Code: BNCLSR85A21F205X
This Quotation Estimate is issued by Clinica Oculistica Milano to provide a comprehensive breakdown of the professional Ophthalmologist services to be rendered to the client at our facility located in the heart of Italy Milan. The following itemized services have been recommended following the initial diagnostic consultation conducted on 02 June 2025. All procedures will be performed by board-certified ophthalmologists registered with the Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Milano.
| Ref. | Description of Ophthalmologist Service | Duration / Sessions | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Diagnostic Assessment – Includes slit-lamp biomicroscopy, tonometry, optical coherence tomography (OCT), visual field perimetry, and retinal fundus photography. Performed by the lead Ophthalmologist in Milan. | 1 session (90 min) | € 285.00 | € 285.00 |
| 02 | Anterior Segment Surgical Procedure – Phacoemulsification cataract surgery with implantation of a premium multifocal intraocular lens (IOL). Performed by the senior Ophthalmologist at the Italy Milan surgical suite. | 1 procedure (approx. 45 min) | € 2,450.00 | € 2,450.00 |
| 03 | Vitreoretinal Consultation & Laser Therapy – Argon laser photocoagulation for early-stage diabetic retinopathy. Conducted by the Ophthalmologist specialist in retinal pathology at our Milan clinic. | 2 sessions (30 min each) | € 320.00 | € 640.00 |
| 04 | Post-Operative Ophthalmologist Follow-Up Visits – A series of four scheduled post-operative reviews to monitor healing, intraocular pressure, and visual acuity recovery. Each visit includes a full examination by the treating Ophthalmologist in Italy Milan. | 4 visits (20 min each) | € 95.00 | € 380.00 |
| 05 | Corneal Topography & Wavefront Analysis – Advanced corneal mapping to assess astigmatism and guide post-surgical refractive correction. Performed using the Zeiss Atlas 900 system at our Italy Milan facility. | 1 session (30 min) | € 180.00 | € 180.00 |
| 06 | Prescription of Post-Operative Medications – Includes topical antibiotic drops, corticosteroid eye drops, and anti-inflammatory agents for a 30-day post-surgical regimen. Dispensed by the in-clinic pharmacy in Milan, Italy. | 1 dispensing | € 78.50 | € 78.50 |
| 07 | Annual Ophthalmologist Preventive Screening Package – A recurring yearly comprehensive eye health check-up including all diagnostic tests listed in item 01, recommended for ongoing monitoring. Valid for the 12-month period following the initial surgery. | 1 annual package | € 350.00 | € 350.00 |
| Subtotal (Services & Procedures) | € 4,363.50 |
| VAT (IVA) – 22% (Italian Standard Rate) | € 959.97 |
| SSN (National Health Service) Reimbursement Deduction | – € 1,245.00 |
| Net Amount Due by Client | € 4,078.47 |
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, all prices for the Ophthalmologist services listed herein are subject to revision based on current Italian healthcare pricing regulations and material costs.
- All Ophthalmologist procedures will be carried out at the Clinica Oculistica Milano facility in Italy Milan, in full compliance with the Italian Ministry of Health (Ministero della Salute) regulations and the Lombardy Regional Health Authority (ASL Milano) operational standards.
- The client acknowledges that the lead Ophthalmologist, Prof. Maria Grazia Conti, holds full professional liability insurance (RC Professionale) with a coverage of € 5,000,000, as mandated by Italian medical practice law (Legge 3/2018).
- Payment for this Quotation Estimate shall be settled as follows: 40% deposit (€ 1,631.39) due upon acceptance of this document; 60% balance (€ 2,447.08) due within fifteen (15) days following the completion of the final post-operative visit. Payment may be made via bank transfer (bonifico bancario) to the IBAN provided on the invoice, or by credit card at the clinic reception in Milan.
- The SSN reimbursement deduction indicated in the totals is an estimate based on the current tariffario SSN for the relevant ATECO codes. The actual reimbursement amount is subject to confirmation by the ASL Milano district office and may vary. The client is advised to submit the "Modulo C" and "Modulo D" forms to their local ASL for reimbursement processing.
- In the event of any surgical complication requiring additional Ophthalmologist intervention beyond the scope of this Quotation Estimate, a supplementary written estimate will be issued and must be signed by the client prior to any additional procedure. No extra charges will be applied without prior written consent.
- All medical records, diagnostic imaging, and surgical reports generated during the treatment period at our Italy Milan clinic will be retained in accordance with Italian data protection law (GDPR – Regolamento UE 2016/679) and the Italian Privacy Code (D.Lgs. 196/2003, as amended by D.Lgs. 101/2018).
- This Quotation Estimate does not constitute a binding contract until formally accepted in writing by both parties. Acceptance may be provided by signing the duplicate copy of this document or by sending a written confirmation to the email address listed above.
- Any disputes arising from the interpretation or execution of this Quotation Estimate for Ophthalmologist services shall be resolved under the jurisdiction of the Tribunale di Milano, Italy, in accordance with Italian civil law.
For and on behalf of Clinica Oculistica Milano
Prof. Maria Grazia Conti, MD, PhD
Lead Ophthalmologist & Medical Director
Signature & DateClient Acknowledgement & Acceptance
Dr. Alessandro Bianchi
I hereby accept the terms of this Quotation Estimate.
Signature & Date ⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT