Quotation Estimate Ophthalmologist in Kuwait Kuwait City –Free Word Template Download with AI
Al-Nour Vision & Ophthalmology Center
Medical City Complex, Block 2, Street 14, Kuwait Kuwait City
Tel: +965-2244-7890 | Email: [email protected]
Ministry of Health License No. KWD-MH-2024-0871
OFFICIAL QUOTATION ESTIMATE| Patient Name: | Mr. Ahmed Khalid Al-Sabah |
| Civil ID No.: | 2890515-0012-XXXX |
| Contact Number: | +965-9988-4455 |
| Address: | Apartment 12B, Al-Salem Tower, Salmiya, Kuwait Kuwait City |
| Insurance Provider: | Bupa Kuwait (Policy No. BUP-7721-3345) |
This Quotation Estimate has been prepared by our team of board-certified Ophthalmologist specialists at Al-Nour Vision & Ophthalmology Center, located in the heart of Kuwait Kuwait City. The following comprehensive ophthalmic services are included in this estimate. All procedures will be performed by a senior Ophthalmologist with over fifteen years of clinical experience in anterior and posterior segment surgery, refractive correction, and ocular disease management.
| Item No. | Description of Ophthalmologist Service | Qty | Unit Price (KWD) | Total (KWD) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (including visual acuity, intraocular pressure, slit-lamp biomicroscopy, and fundus examination) | 1 | 35.000 | 35.000 |
| 02 | Dilated Fundus Examination with Optical Coherence Tomography (OCT) of the Macula and Optic Nerve | 1 | 55.000 | 55.000 |
| 03 | Corneal Topography & Pachymetry (for refractive surgery assessment by the Ophthalmologist) | 1 | 45.000 | 45.000 |
| 04 | Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implantation (performed by senior Ophthalmologist, including pre-operative and post-operative visits) | 2 (bilateral) | 1,250.000 | 2,500.000 |
| 05 | Post-Operative Ophthalmologist Follow-Up Visits (Week 1, Week 4, and Month 3) including suture check and IOL axis verification | 3 | 25.000 | 75.000 |
| 06 | Prescription of Post-Operative Medications (antibiotic drops, anti-inflammatory drops, and lubricating drops for 6 weeks) | 1 | 48.000 | 48.000 |
| 07 | Annual Comprehensive Eye Health Screening for Family Members (up to 4 dependents, performed by Ophthalmologist team) | 4 | 60.000 | 240.000 |
| 08 | Emergency Ophthalmologist On-Call Coverage (24/7 access to our Kuwait Kuwait City facility for the duration of the treatment plan) | 1 | 120.000 | 120.000 |
| Subtotal | 3,118.000 | |||
| VAT (5% – Kuwait Tax Authority) | 155.900 | |||
| GRAND TOTAL (KWD) | 3,273.900 | |||
This Quotation Estimate covers all standard Ophthalmologist services as itemized above. Should additional diagnostic imaging, specialized retinal procedures, or unexpected intra-operative findings necessitate further intervention, a supplementary Quotation Estimate will be issued and require the patient's written consent prior to any additional procedure. All Ophthalmologist consultations and surgical procedures are conducted in compliance with the regulations set forth by the Kuwait Ministry of Health and the Kuwait Medical Specialties Board. Our facility in Kuwait Kuwait City is fully equipped with state-of-the-art surgical microscopes, femtosecond laser systems, and diagnostic imaging suites to ensure the highest standard of ophthalmic care.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision based on current market rates and supply costs in Kuwait Kuwait City.
- Payment terms: 50% deposit is due upon acceptance of this Quotation Estimate to reserve the Ophthalmologist's surgical schedule. The remaining 50% balance is payable within seven (7) days following the completion of all scheduled procedures.
- Insurance claims: Our billing department in Kuwait Kuwait City will process all applicable insurance reimbursements directly with Bupa Kuwait or the patient's designated provider. The patient is responsible for any co-pay or non-covered amounts as per their policy terms.
- Cancellation policy: Should the patient need to reschedule or cancel a booked Ophthalmologist appointment, a 48-hour advance notice is required. Cancellations within 48 hours will incur a 20% administrative fee on the scheduled procedure cost.
- All medical records, surgical reports, and Ophthalmologist notes generated during the course of treatment will be maintained in accordance with Kuwait's data protection and patient confidentiality laws.
- This Quotation Estimate does not constitute a guarantee of specific surgical outcomes. The treating Ophthalmologist will discuss all potential risks, benefits, and alternatives during the pre-operative consultation.
- Any dispute arising from this Quotation Estimate shall be governed by the laws of the State of Kuwait and adjudicated in the competent courts of Kuwait Kuwait City.
By signing below, the patient (or authorized guardian) acknowledges receipt and acceptance of this Quotation Estimate for the Ophthalmologist services described herein. The undersigned agrees to all terms and conditions outlined in Section 5 and authorizes Al-Nour Vision & Ophthalmology Center to proceed with the scheduled care plan in Kuwait Kuwait City.
Patient / Authorized Guardian SignatureName: _________________________
Date: _________________________ For Al-Nour Vision & Ophthalmology Center
Dr. Faisal Al-Mutairi, Lead Ophthalmologist
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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