Quotation Estimate Ophthalmologist in Malaysia Kuala Lumpur –Free Word Template Download with AI

Quotation No: QTE-2025-KL-0783 Date Issued: 15 June 2025 Valid Until: 15 July 2025 Prepared By: Dr. Aishwariya Raman, Consultant Ophthalmologist 1. Client / Recipient Details

Client Name:	Tan Wei Ming
Address:	Unit 24-08, The Gardens Residence, 8 Jalan Kiara, 50480 Malaysia Kuala Lumpur
Contact Number:	+6012-345 6789
Email:	[email protected]
IC / Passport No:	850412-14-5521

2. Scope of Ophthalmologist Services

This Quotation Estimate is issued by KL Vision Care Ophthalmology Centre, a licensed and accredited eye care facility located in the heart of Malaysia Kuala Lumpur, to provide a comprehensive breakdown of professional Ophthalmologist services, diagnostic procedures, and associated medical treatments. Our team of board-certified Ophthalmologists adheres to the highest clinical standards as mandated by the Malaysian Medical Council (MMC) and the Ministry of Health Malaysia (MOH).

3. Itemised Cost Breakdown

No.	Description of Ophthalmologist Service	Qty	Unit Price (MYR)	Amount (MYR)
1	Comprehensive Ophthalmologist Consultation – Initial Assessment & Visual Acuity Testing	1	RM 350.00	RM 350.00
2	Dilated Fundus Examination by Senior Ophthalmologist (including mydriatic drops)	1	RM 280.00	RM 280.00
3	Optical Coherence Tomography (OCT) – Macular & Retinal Imaging	2	RM 450.00	RM 900.00
4	Anterior Segment Biometry & Corneal Topography (for refractive surgery planning)	1	RM 620.00	RM 620.00
5	Intraocular Pressure Measurement (Non-Contact Tonometry) – 3 readings	1	RM 120.00	RM 120.00
6	Slit-Lamp Biomicroscopy Examination (Bilateral)	1	RM 200.00	RM 200.00
7	Colour Fundus Photography (Bilateral, 45-degree field)	1	RM 380.00	RM 380.00
8	Visual Field Perimetry (Humphrey 24-2 Standard Threshold)	2	RM 300.00	RM 600.00
9	Follow-up Ophthalmologist Review (within 4 weeks of initial consultation)	1	RM 250.00	RM 250.00
10	Prescription of Topical Ophthalmic Medications (30-day supply, both eyes)	1	RM 185.00	RM 185.00
11	Written Ophthalmologist Report & Diagnostic Summary (for employer / insurance purposes)	1	RM 150.00	RM 150.00
12	Administrative & Facility Fee (KL Vision Care, Malaysia Kuala Lumpur)	1	RM 100.00	RM 100.00
Subtotal				RM 4,535.00
Sales & Service Tax (SST) @ 6%				RM 272.10
TOTAL AMOUNT DUE (MYR)				RM 4,807.10

Note: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. All prices are quoted in Malaysian Ringgit (MYR) and are subject to revision should there be changes in government tax policy or medical supply costs within Malaysia Kuala Lumpur. This estimate does not include emergency surgical interventions, which will be separately quoted upon clinical necessity. 4. Terms and Conditions

Validity: This Quotation Estimate shall remain valid for thirty (30) days from the date of issuance. Beyond this period, the Ophthalmologist service fees may be subject to revision based on prevailing medical cost indices in Malaysia Kuala Lumpur.
Payment Terms: Full payment is due within fourteen (14) days of the date of this Quotation Estimate. Payment may be made via bank transfer to KL Vision Care Ophthalmology Centre, Maybank Account No. 5123-4567-8901, or via credit/debit card at our Malaysia Kuala Lumpur facility.
Insurance & Claims: This Quotation Estimate may be submitted to your medical insurance provider or employer's health benefit scheme. Our Ophthalmologist team will provide all necessary documentation, including itemised invoices and clinical reports, to facilitate claims processing in accordance with Malaysian insurance regulations.
Cancellation Policy: Appointments may be rescheduled up to 48 hours in advance without charge. Cancellations made within 48 hours of the scheduled Ophthalmologist consultation will incur a 50% administrative fee of the consultation charge.
Confidentiality: All patient records, diagnostic imaging, and clinical findings obtained during Ophthalmologist consultations at our Malaysia Kuala Lumpur centre are protected under the Personal Data Protection Act 2010 (PDPA) of Malaysia. No information shall be disclosed without written consent from the patient.
Scope Limitation: This Quotation Estimate covers only the diagnostic and consultative services listed above. Any additional procedures, surgical interventions, or specialist referrals identified during the Ophthalmologist examination will be communicated to the patient prior to commencement and will be subject to a separate written quotation.
Governing Law: This Quotation Estimate and all associated services shall be governed by and construed in accordance with the laws of Malaysia. Any disputes shall be subject to the exclusive jurisdiction of the courts of Malaysia Kuala Lumpur.

5. Acceptance and Authorisation

By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services at KL Vision Care Ophthalmology Centre, Malaysia Kuala Lumpur, and agrees to the terms and conditions outlined herein.

For and on behalf of KL Vision Care Ophthalmology Centre
Dr. Aishwariya Raman, Consultant Ophthalmologist
Date: _______________ Client / Authorised Representative
Name: Tan Wei Ming
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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