Quotation Estimate Ophthalmologist in Peru Lima –Free Word Template Download with AI
Clínica Ocular del Pacífico S.A.C.
Ophthalmologist & Vision Care Center
Av. Javier Prado Este 1250, San Isidro, Peru Lima
RUC: 20587432190 | Tel: +51 1 445-6789 | Email: [email protected]
| Client Name: Ing. Ricardo Mendoza Salazar | DNI / RUC: 45872316 |
| Address: Jr. Las Begonias 456, Miraflores, Peru Lima | Contact: +51 987-654-321 |
| Email: [email protected] | Insurance Provider: Seguros Pacífico (Policy #SP-2024-88912) |
This Quotation Estimate is issued by Clínica Ocular del Pacífico S.A.C., a certified ophthalmology center located in the heart of Peru Lima, to provide a comprehensive breakdown of professional Ophthalmologist services requested by the client. Our team of board-certified Ophthalmologist specialists in Peru Lima offers state-of-the-art diagnostic and therapeutic eye care, utilizing the latest technology available in the Peruvian medical sector. The following services have been evaluated based on the initial consultation conducted on June 10, 2025, at our Peru Lima facility.
| Item # | Description of Ophthalmologist Service | Qty | Unit Price (S/) | Subtotal (S/) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & Visual Acuity Assessment (includes refraction, intraocular pressure measurement, and fundus examination) | 1 | 350.00 | 350.00 |
| 02 | Dilated Fundus Examination with Digital Retinal Photography (Ophthalmologist supervised) | 2 | 280.00 | 560.00 |
| 03 | Optical Coherence Tomography (OCT) – Macular & Retinal Nerve Fiber Layer Analysis | 1 | 420.00 | 420.00 |
| 04 | Anterior Segment Biometry & Corneal Topography (for Ophthalmologist surgical planning) | 1 | 380.00 | 380.00 |
| 05 | Phacoemulsification Cataract Surgery – Monofocal IOL (performed by senior Ophthalmologist, includes pre-op and post-op visits) | 2 | 4,850.00 | 9,700.00 |
| 06 | Post-Surgical Ophthalmologist Follow-up Visits (Week 1, Week 4, Month 3) – Peru Lima clinic | 6 | 180.00 | 1,080.00 |
| 07 | Prescription of Post-Operative Medications (antibiotic drops, anti-inflammatory drops, lubricant drops – 30-day supply) | 1 | 295.00 | 295.00 |
| 08 | Emergency Ophthalmologist On-Call Coverage (24/7 availability during surgical recovery period in Peru Lima) | 1 | 500.00 | 500.00 |
| SUBTOTAL (S/) | 13,285.00 | |||
| IGV (18% Tax – Peru) | 2,391.30 | |||
| TOTAL QUOTATION ESTIMATE (S/) | 15,676.30 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, prices for Ophthalmologist services in Peru Lima may be subject to revision due to medical supply costs, currency fluctuations, or updated fee schedules established by the Peruvian Ministry of Health (MINSA).
- All Ophthalmologist procedures listed in this Quotation Estimate will be performed at our primary facility located in San Isidro, Peru Lima, or at the affiliated surgical center in Miraflores, Peru Lima, as determined by the attending Ophthalmologist based on the patient's clinical needs.
- The total amount stated in this Quotation Estimate is inclusive of all diagnostic tests, surgical materials, intraocular lenses, anesthesia fees, and hospitalization charges for the duration of the procedure. No additional charges will be applied unless unforeseen medical complications arise, in which case a supplementary Quotation Estimate will be issued and approved by the client prior to any additional intervention.
- Payment terms: 50% advance payment upon acceptance of this Quotation Estimate, and the remaining 50% within five (5) business days following the completion of the final post-operative Ophthalmologist follow-up visit in Peru Lima. Payment may be made via bank transfer to BCP, Interbank, or BBVA accounts, or by credit card (Visa, Mastercard, American Express).
- Insurance coverage: This Quotation Estimate has been prepared to align with the coverage terms of Seguros Pacífico policy #SP-2024-88912. The client is advised to confirm the exact reimbursement percentage directly with their insurance provider. Any co-pay or non-covered amounts shall be the responsibility of the client.
- All Ophthalmologist services are performed in strict compliance with the regulations established by the Peruvian College of Ophthalmologists (Colegio de Oftalmólogos del Perú) and the technical standards set forth by the Superintendencia Nacional de Salud (SUSALUD) in Peru Lima.
- Medical records, diagnostic imaging, and surgical reports generated during the course of treatment will be provided to the client in both digital (PDF) and physical format upon request, in accordance with Peruvian data protection law (Ley N° 29733).
Important: As a recognized Ophthalmologist center in Peru Lima, Clínica Ocular del Pacífico S.A.C. maintains a 24-hour emergency response line for post-surgical patients. The attending Ophthalmologist will personally oversee the complete recovery protocol. Clients residing in the Lima metropolitan area (including Callao, Surco, La Molina, and other districts of Peru Lima) may schedule follow-up appointments at any of our three Peru Lima locations without additional travel-related fees.
We appreciate the opportunity to provide this detailed Quotation Estimate for your Ophthalmologist care needs. Our dedicated team in Peru Lima is committed to delivering the highest standard of ophthalmic care with compassion, precision, and transparency. Should you require any clarification, additional services, or modifications to this Quotation Estimate, please do not hesitate to contact our patient services department at +51 1 445-6789 or via email at [email protected].
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions outlined herein for the Ophthalmologist services to be rendered in Peru Lima.
Client Signature
Ing. Ricardo Mendoza Salazar
DNI: 45872316
Date: _______________
Authorized Representative
Dr. Elena Quispe Ramírez, MD
Ophthalmologist – Director
Clínica Ocular del Pacífico S.A.C.
Peru Lima
Date: _______________
Create your own Word template with our GoGPT AI prompt:
GoGPT