Quotation Estimate Ophthalmologist in Mexico Mexico City –Free Word Template Download with AI

This Quotation Estimate is issued by Clínica Ocular del Valle, a licensed Ophthalmologist practice operating in Mexico Mexico City, to provide a comprehensive breakdown of professional ophthalmological services, diagnostic procedures, and associated medical supplies. The following Ophthalmologist services have been recommended following the initial consultation conducted on June 5, 2025, at our Mexico Mexico City facility located in the Benito Juárez borough.

All Ophthalmologist procedures listed below will be performed by Dr. Alejandro Ramírez Torres, M.D., a board-certified Ophthalmologist registered with the Consejo Mexicano de Oftalmología (License No. OFT-2019-4471) and affiliated with the Colegio de Médicos de Mexico Mexico City.

• This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After this period, prices for Ophthalmologist services may be subject to revision based on current Mexico Mexico City medical service fee schedules.
• All Ophthalmologist procedures will be performed at our Mexico Mexico City clinic facility, Av. Insurgentes Sur 1234, Col. Del Valle, Benito Juárez, 03100. The client is responsible for transportation to and from the Mexico Mexico City location.
• Payment is due within fifteen (15) business days from the date of this Quotation Estimate. Accepted payment methods include: bank transfer (SPEI), credit/debit card (Visa, Mastercard, American Express), and cash at the Mexico Mexico City clinic reception.
• Insurance coverage: This Quotation Estimate has been prepared to align with GNP Seguros policy GNP-778213. The client is advised to confirm pre-authorization with their insurance provider before scheduling Ophthalmologist procedures. Any amounts not covered by insurance are the sole responsibility of the client.
• The Ophthalmologist services described herein comply with the regulations established by the Secretaría de Salud de Mexico Mexico City and the Norma Oficial Mexicana NOM-022-SSA3-2012 regarding medical practice standards.
• Cancellations or rescheduling of Ophthalmologist appointments must be made at least forty-eight (48) hours in advance. Late cancellations may incur a 20% administrative fee on the scheduled Ophthalmologist service fee.
• All medical data and Ophthalmologist reports generated from this engagement are protected under the Ley Federal de Protección de Datos Personales en Posesión de los Particulares (Mexico, 2010). Data will be stored in compliance with Mexico Mexico City health authority regulations.
• This Quotation Estimate does not constitute a binding contract until formally accepted in writing by both parties. Acceptance may be provided via signed copy, email confirmation, or electronic signature through our Mexico Mexico City patient portal.
• Any additional Ophthalmologist procedures identified during the course of treatment that are not included in this Quotation Estimate will require a separate written authorization and supplementary Quotation Estimate before execution.

Clínica Ocular del Valle is a specialized Ophthalmologist center located in the heart of Mexico Mexico City, serving patients from all sixteen boroughs of the capital. Our Ophthalmologist team consists of twelve board-certified specialists in general ophthalmology, retina, cornea, glaucoma, pediatric ophthalmology, and ocular plastic surgery. The facility is equipped with state-of-the-art diagnostic technology and operates Monday through Saturday, from 8:00 AM to 8:00 PM, to accommodate the diverse schedules of Mexico Mexico City residents.

This Quotation Estimate reflects the standard fee schedule for Ophthalmologist services in Mexico Mexico City as of June 2025. All prices are inclusive of medical supplies consumed during the procedure but exclusive of any emergency or surgical interventions not listed above.

By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Mexico Mexico City and agrees to the terms and conditions outlined herein. The Ophthalmologist practice confirms that all listed services will be rendered in accordance with the highest standards of ophthalmological care as practiced in Mexico Mexico City.