Quotation Estimate Ophthalmologist in Nepal Kathmandu –Free Word Template Download with AI
Clear Vision Eye Care Centre
Thamel Marg, Kathmandu, Nepal | Phone: +977-1-4412345 | Email: [email protected]
Licence No: NMC/OPH/2021/0456 | VAT Reg: 101234567
This Quotation Estimate is issued by Clear Vision Eye Care Centre, a leading ophthalmology practice located in the heart of Nepal Kathmandu, to provide Mr. Rajesh Shrestha with a detailed and transparent breakdown of all recommended ophthalmological services, diagnostic procedures, and surgical interventions. As a certified Ophthalmologist with over fifteen years of clinical experience in the Kathmandu Valley, Dr. Anita Gurung and her team are committed to delivering world-class eye care at competitive rates appropriate for the Nepal Kathmandu healthcare market. This document serves as a formal Quotation Estimate and does not constitute a binding contract until both parties have signed and accepted the terms outlined herein.
| S.No | Service / Procedure Description | Category | Qty | Unit Price (NPR) | Total (NPR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation (Initial Assessment, Visual Acuity Test, Slit Lamp Examination, Intraocular Pressure Measurement) | Consultation | 1 | 2,500 | 2,500 |
| 2 | Dilated Fundus Examination with Digital Retinal Imaging (Both Eyes) | Diagnostic | 1 | 3,200 | 3,200 |
| 3 | Optical Coherence Tomography (OCT) – Macular & Retinal Nerve Fibre Layer Analysis | Diagnostic | 1 | 4,500 | 4,500 |
| 4 | Automated Refraction and Custom Prescription Lenses (Bifocal, Anti-Blue Light Coating) | Optical | 1 pair | 12,000 | 12,000 |
| 5 | Phacoemulsification Cataract Surgery with Premium IOL (Intraocular Lens) – Right Eye | Surgical | 1 | 45,000 | 45,000 |
| 6 | Post-Surgical Follow-Up Visits with the Ophthalmologist (3 sessions over 6 weeks) | Follow-Up | 3 | 1,500 | 4,500 |
| 7 | Prescription Medications (Antibiotic Eye Drops, Anti-Inflammatory Drops, Lubricant Drops – 30-day supply) | Pharmacy | 1 | 3,800 | 3,800 |
| 8 | Annual Comprehensive Eye Health Screening Package (for family members, up to 4 persons) | Preventive | 4 | 3,500 | 14,000 |
| Subtotal (NPR) | 89,500 | ||||
| VAT (13%) | 11,635 | ||||
| Grand Total (NPR) | 101,135 | ||||
Clear Vision Eye Care Centre, situated in the central district of Kathmandu, provides a full spectrum of ophthalmological care. The Ophthalmologist team at our facility handles conditions ranging from routine refractive errors (myopia, hyperopia, astigmatism, presbyopia) to complex surgical cases including cataracts, glaucoma, diabetic retinopathy, corneal transplants, and retinal detachment repairs. Our practice in Nepal Kathmandu is equipped with state-of-the-art diagnostic technology, including spectral-domain OCT, fundus autofluorescence imaging, and femtosecond laser-assisted surgical platforms. This Quotation Estimate covers the specific services recommended for the patient following the initial diagnostic evaluation conducted on 10 June 2025.
Important Terms Governing This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be revised to reflect current market conditions in Nepal Kathmandu.
- Payment for surgical procedures (Item 5) requires a 50% advance deposit at the time of scheduling, with the remaining balance payable within seven (7) days post-surgery.
- Consultation, diagnostic, and optical services (Items 1–4) are payable in full at the time of service delivery.
- The Ophthalmologist reserves the right to modify the surgical plan intraoperatively if unforeseen clinical findings necessitate additional procedures. Any such additions will be communicated to the patient or guardian prior to implementation, and a supplementary Quotation Estimate will be issued.
- All services are subject to the medical ethics and professional conduct standards set by the Nepal Medical Council (NMC) and the Kathmandu Valley Health Authority.
- Post-surgical complications, if any, will be managed by the treating Ophthalmologist at no additional consultation fee within the first ninety (90) days. Medications and additional imaging beyond the quoted scope will be billed separately.
- This Quotation Estimate does not include hospitalization charges beyond the day-surgery facility. If overnight admission becomes necessary, additional costs will apply as per the hospital's standard tariff in Nepal Kathmandu.
- Insurance claims: The patient is responsible for coordinating with their health insurance provider. Our office will provide all necessary documentation, including this Quotation Estimate, diagnostic reports, and itemized invoices, to facilitate the claim process.
- Confidentiality: All patient records, diagnostic images, and treatment details are protected under Nepal's Personal Data Protection Act, 2075 (2018). No information will be disclosed without written consent.
By signing below, the patient (or authorized guardian) acknowledges receipt of this Quotation Estimate for the recommended Ophthalmologist services at Clear Vision Eye Care Centre, Nepal Kathmandu, and agrees to the terms and conditions outlined in Section 4. The treating Ophthalmologist confirms that the clinical recommendations herein are based on a thorough examination and represent the standard of care appropriate for the diagnosed condition.
Patient / Authorized GuardianName: _________________________
Signature: _________________________
Date: _________________________ Treating Ophthalmologist
Name: Dr. Anita Gurung, MD
Signature: _________________________
Date: _________________________
NMC Registration: 2021/0456 ⬇️ Download as DOCX Edit online as DOCX
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