Quotation Estimate Ophthalmologist in Italy Naples –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — Naples, Italy
Document Reference: QTE-NAP-2025-04712 | Validity: 60 Days from Issue Date
Provider (Ophthalmologist Practice)
Clinica Oculistica del Golfo
Via Toledo 142, 80132 Naples (Napoli), Italy
Phone: +39 081 555 0142
Email: [email protected]
VAT (P.IVA): IT02345678901
Specialist: Dr. Marco Esposito, MD, PhD in Ophthalmology
Client / Patient
Mr. / Ms. [Full Name]
Address: [Street, City, Province], Italy
Phone: [Contact Number]
Email: [Email Address]
SSN (Codice Fiscale): [Tax Code]
Referring Physician: [Name, if applicable]
Quotation Estimate Summary: This Quotation Estimate is issued by Clinica Oculistica del Golfo, a licensed ophthalmology practice located in the historic centre of Naples, Italy, to provide a detailed and transparent cost breakdown for the full spectrum of ophthalmologist services requested by the client. All prices are expressed in Euros (EUR) and include applicable Italian Value Added Tax (IVA) at the standard rate of 22%, unless otherwise noted. This Quotation Estimate reflects current market rates for ophthalmologist consultations and procedures in the Naples metropolitan area as of the issue date.| Ref. | Service Description | Ophthalmologist Specialist | Qty | Unit Price (EUR) | Subtotal (EUR) |
|---|---|---|---|---|---|
| 01 | Initial Ophthalmologist Consultation & Comprehensive Eye Examination (visual acuity, intraocular pressure, slit-lamp biomicroscopy, fundus examination) | Dr. M. Esposito | 1 | 120.00 | 120.00 |
| 02 | Dilated Pupil Examination with Mydriatic Drops (Tropicamide 1%) and Retinal Assessment | Dr. M. Esposito | 1 | 45.00 | 45.00 |
| 03 | Optical Coherence Tomography (OCT) of the Macula and Optic Nerve Head — Bilateral | Dr. L. Ferrante | 1 | 95.00 | 95.00 |
| 04 | Automated Perimetry (Humphrey 24-2) for Visual Field Mapping — Both Eyes | Dr. L. Ferrante | 1 | 80.00 | 80.00 |
| 05 | Anterior Segment Ultrasound (A-Scan) and Biometry for Refractive Surgery Planning | Dr. A. De Luca | 1 | 70.00 | 70.00 |
| 06 | Corneal Topography (Pentacam HR) — Bilateral Analysis | Dr. A. De Luca | 1 | 65.00 | 65.00 |
| 07 | Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implantation (per eye) | Dr. M. Esposito | 2 | 1,450.00 | 2,900.00 |
| 08 | Post-Operative Ophthalmologist Follow-Up Visits (Week 1, Week 4, Month 3) — Naples Clinic | Dr. M. Esposito | 3 | 55.00 | 165.00 |
| 09 | Prescription of Custom Contact Lenses or Corrective Eyewear (frame and lenses included) | Optician Partner | 1 | 320.00 | 320.00 |
| 10 | Annual Ophthalmologist Preventive Screening Package (Naples, Italy — includes all diagnostic tests above) | Dr. M. Esposito | 1 | 250.00 | 250.00 |
| SUBTOTAL (excl. IVA) | 4,160.00 | ||||
| IVA 22% (Italian VAT) | 915.20 | ||||
| TOTAL AMOUNT DUE (EUR) | 5,075.20 | ||||
- This Quotation Estimate is valid for a period of sixty (60) calendar days from the date of issue. After this period, the ophthalmologist service fees listed herein may be subject to revision in accordance with the prevailing healthcare pricing regulations in Naples, Italy.
- All ophthalmologist procedures and consultations referenced in this Quotation Estimate will be performed at the Clinica Oculistica del Golfo facility located in Naples, Italy, or at an affiliated surgical centre in the Campania region as pre-agreed with the client.
- Payment terms: 30% deposit upon acceptance of this Quotation Estimate; the remaining 70% is due within fifteen (15) business days following the completion of all ophthalmologist services. Payment may be made via bank transfer (IBAN: IT60 X054 2811 1000 0001 2345 678), credit card, or cash at the Naples clinic reception.
- This Quotation Estimate does not constitute a binding contract until formally accepted in writing by both parties. The client's signature below indicates acceptance of the ophthalmologist services, pricing, and terms outlined in this document.
- Any additional ophthalmologist interventions, emergency consultations, or diagnostic tests not explicitly listed in this Quotation Estimate will be quoted separately at the standard rates of the Naples practice and require prior written consent from the client.
- The ophthalmologist team at Clinica Oculistica del Golfo operates in full compliance with the Italian Ministry of Health (Ministero della Salute) regulations, the professional code of ethics of the Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Napoli, and all applicable EU medical device and pharmaceutical directives.
- Confidentiality: All patient data, diagnostic imaging, and clinical records generated during the ophthalmologist services described in this Quotation Estimate are protected under Italian data protection law (D.Lgs. 196/2003) and the EU General Data Protection Regulation (GDPR, Regulation 2016/679).
- Warranty: The ophthalmologist surgical procedures (Item 07) carry a clinical warranty of twelve (12) months from the date of surgery, covering re-intervention for lens dislocation or significant refractive error attributable to the surgical technique, as assessed by the treating ophthalmologist in Naples.
- Dispute resolution: Any disagreement arising from this Quotation Estimate or the subsequent ophthalmologist services shall be resolved amicably. Failing mutual agreement, the matter shall be submitted to the competent civil court of Naples, Italy, in accordance with Italian procedural law.
- This Quotation Estimate is issued in the English language for the convenience of the client. In the event of any discrepancy between the English version and an Italian-language version, the Italian version shall prevail under the laws of Italy.
For Clinica Oculistica del Golfo (Ophthalmologist Practice)
Dr. Marco Esposito, MD, PhDLead Ophthalmologist & Director
Date: ______________________
For the Client / Patient
[Full Name]Accepted & Agreed
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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