Quotation Estimate Ophthalmologist in Russia Moscow –Free Word Template Download with AI
12 Tverskaya Street, Building 4, Moscow, 125009, Russian Federation
Phone: +7 (495) 123-4567 | Email: [email protected]
License No. ЛО-77-01-003456 | OGRN: 1097746123456
Quotation EstimateQuotation Details
Quotation No.: QTE-MSC-2025-00847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Currency: Russian Rubles (RUB / ₽)
Client Information
Client Name: ___________________________
Address: Moscow, Russian Federation
Passport / ID No.: ___________________________
Phone: ___________________________
Dear Valued Client,
Thank you for your interest in the professional Ophthalmologist services provided by Moscow Vision Care Center. This Quotation Estimate has been prepared specifically for your ophthalmological consultation and treatment needs within the city of Russia Moscow. Our team of certified ophthalmologists operates in full compliance with the Federal Law of the Russian Federation on Healthcare (No. 323-FZ) and all applicable regulations governing medical practice in Moscow.
Scope of Ophthalmologist ServicesThe following Quotation Estimate covers a comprehensive range of ophthalmological services delivered by our senior Ophthalmologist team at our clinic located in the central district of Russia Moscow. All procedures are performed using state-of-the-art diagnostic and therapeutic equipment imported and certified for use in the Russian Federation.
| No. | Service Description | Ophthalmologist Specialist | Qty | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Visual Acuity Assessment | Dr. A. Petrov, MD, PhD | 1 | 3,500 | 3,500 |
| 2 | Dilated Fundus Examination & Optical Coherence Tomography (OCT) | Dr. A. Petrov, MD, PhD | 1 | 4,200 | 4,200 |
| 3 | Non-Contact Intraocular Pressure Measurement (Tonometry) | Dr. E. Smirnova, MD | 1 | 1,800 | 1,800 |
| 4 | Corneal Topography & Pachymetry Analysis | Dr. E. Smirnova, MD | 1 | 2,600 | 2,600 |
| 5 | Peripheral Retinal Examination with Indirect Ophthalmoscope | Dr. A. Petrov, MD, PhD | 1 | 2,200 | 2,200 |
| 6 | Color Vision Testing (Ishihara & Farnsworth Panels) | Dr. M. Ivanov, MD | 1 | 1,200 | 1,200 |
| 7 | Prescription of Corrective Lenses (Spectacles / Contact Lenses) | Dr. M. Ivanov, MD | 1 | 1,500 | 1,500 |
| 8 | Follow-up Ophthalmologist Review (within 30 days) | Dr. A. Petrov, MD, PhD | 1 | 2,000 | 2,000 |
| 9 | Written Medical Report & Diagnostic Summary (in Russian & English) | Clinical Administration | 1 | 1,000 | 1,000 |
| 10 | Pharmaceutical Guidance & Prescription Issuance (Moscow Pharmacy Network) | Dr. E. Smirnova, MD | 1 | 800 | 800 |
| Subtotal (Services 1–10) | 20,800 RUB |
| VAT (20% – per Russian Tax Code) | 4,160 RUB |
| Grand Total | 24,960 RUB |
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing for the Ophthalmologist services listed herein may be subject to revision in accordance with current Moscow medical service tariffs.
- All ophthalmological procedures described in this estimate will be performed at our registered facility in Russia Moscow (Tverskaya Street, 12, Bldg. 4) during standard operating hours: Monday through Friday, 08:00–20:00; Saturday, 09:00–16:00 (Moscow Time, UTC+3).
- The client is required to present a valid Russian Federation passport or foreign citizen identification document, along with a mandatory medical insurance policy (OMS/DMS) or proof of self-payment, at the time of the Ophthalmologist appointment.
- Payment for the services outlined in this Quotation Estimate may be made via bank transfer to the account of Moscow Vision Care Center (Bank: Sberbank, Moscow Branch; Account: 40703 810 3 0000 0012345; BIC: 044525225), by cash at the clinic reception, or by major credit/debit cards accepted in Moscow.
- A 50% prepayment is required to confirm the Ophthalmologist appointment slot. The remaining balance is due on the day of service or within five (5) business days thereafter.
- All medical records, diagnostic images, and the written report generated during the Ophthalmologist consultation are the property of the client and are stored in accordance with Russian Federal Law No. 152-FZ on Personal Data Protection.
- This Quotation Estimate does not constitute a binding medical contract. A separate informed consent form, compliant with the regulations of the Ministry of Health of the Russian Federation, must be signed by the client prior to any diagnostic or therapeutic procedure.
- In the event of emergency ophthalmological intervention not covered by this estimate, the Ophthalmologist on duty will provide a supplementary written estimate for the client's approval before proceeding.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the civil legislation of the Russian Federation and, where applicable, through the Arbitration Court of the city of Moscow.
- Our clinic maintains full liability insurance coverage for all Ophthalmologist procedures performed in Russia Moscow, with a policy limit of 10,000,000 RUB per incident.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Russia Moscow and agrees to the terms and conditions stated above. This document serves as a formal price indication and does not obligate either party to enter into a service contract until a separate agreement is executed.
Prepared by (Clinic Representative):
Dr. Alexander Petrov, MD, PhD
Chief Ophthalmologist
Moscow Vision Care Center
Signature: ___________________________
Date: 15 June 2025
Accepted by (Client):
Name: ___________________________
Passport / ID No.: ___________________________
Signature: ___________________________
Date: ___________________________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT