Quotation Estimate Ophthalmologist in Russia Saint Petersburg –Free Word Template Download with AI
12 Nevsky Prospekt, Saint Petersburg, Russia 191011
Phone: +7 (812) 555-0142 | Email: [email protected]
License No. ЛО-78-01-003456 | OGRN: 1157847012345
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-SPB-0487
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Elena V. Sokolova, Lead Ophthalmologist
Client Information
Client Name: [Client Full Name]
Address: [Client Address], Saint Petersburg, Russia
Phone: [Client Phone Number]
Email: [Client Email Address]
Dear Valued Client,
Thank you for your interest in the comprehensive ophthalmological services provided by Neva Vision Medical Center in Russia Saint Petersburg. This Quotation Estimate has been carefully prepared to outline the full scope of Ophthalmologist services, associated diagnostic procedures, and estimated costs for your planned eye care treatment. Our team of experienced Ophthalmologist specialists in Russia Saint Petersburg is committed to delivering the highest standard of ocular healthcare, and this document serves as a transparent financial overview of the services you may require.
Scope of Ophthalmologist ServicesThe following Quotation Estimate covers a complete ophthalmological assessment and treatment plan as recommended by our senior Ophthalmologist in Russia Saint Petersburg. All services are performed in accordance with the current Russian Federal Medical Standards and the guidelines established by the Ministry of Health of the Russian Federation. The Ophthalmologist team at our facility in Russia Saint Petersburg utilizes state-of-the-art diagnostic and therapeutic equipment to ensure accurate diagnosis and effective treatment outcomes.
Itemized Cost Breakdown| No. | Service / Procedure Description | Quantity | Unit Price (RUB) | Total (RUB) | Duration |
|---|---|---|---|---|---|
| 1 | Initial Ophthalmologist Consultation & Comprehensive Eye Examination (visual acuity, refraction, intraocular pressure, slit-lamp biomicroscopy) | 1 | 4,500 | 4,500 | 45 min |
| 2 | OCT (Optical Coherence Tomography) of the Retina & Macula – performed by Ophthalmologist specialist | 2 | 3,200 | 6,400 | 20 min |
| 3 | Dilated Fundus Examination with Mydriatic Drops – conducted by the treating Ophthalmologist | 1 | 2,800 | 2,800 | 30 min |
| 4 | Visual Field Perimetry (Humphrey 30-2) – Ophthalmologist-supervised diagnostic test | 1 | 3,500 | 3,500 | 25 min |
| 5 | Corneal Topography & Pachymetry – Ophthalmologist assessment for refractive planning | 1 | 2,900 | 2,900 | 15 min |
| 6 | Anterior Segment Ultrasound Biometry (IOL Calculation) – Ophthalmologist procedure | 1 | 2,200 | 2,200 | 15 min |
| 7 | Phacoemulsification Cataract Surgery with Premium Toric IOL Implantation – performed by Lead Ophthalmologist | 1 | 85,000 | 85,000 | 60 min |
| 8 | Post-Operative Ophthalmologist Follow-Up Visits (Day 1, Week 1, Month 1, Month 3) | 4 | 2,500 | 10,000 | 20 min each |
| 9 | Prescription Medications & Post-Operative Eye Drops (30-day supply) | 1 | 4,800 | 4,800 | N/A |
| 10 | Custom Prescription Spectacles (single-vision, anti-reflective coating) – dispensed by Ophthalmologist | 1 | 12,000 | 12,000 | 7 days |
| TOTAL ESTIMATED COST (RUB) | 134,100 | — | |||
| TOTAL ESTIMATED COST (USD, approx. at 92 RUB/USD) | ≈ 1,458 | — | |||
- 1. This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiration date, pricing for Ophthalmologist services in Russia Saint Petersburg may be subject to revision based on current market conditions and regulatory adjustments.
- 2. All Ophthalmologist procedures listed in this Quotation Estimate are to be performed at the Neva Vision Medical Center facility located in Russia Saint Petersburg. No services will be rendered at alternative locations unless explicitly agreed upon in writing.
- 3. The total cost indicated in this Quotation Estimate is an estimate and may vary by up to 10% depending on intra-operative findings, the specific Ophthalmologist technique required, or additional diagnostic needs identified during the initial examination.
- 4. Payment terms: 50% deposit is due upon acceptance of this Quotation Estimate. The remaining 50% balance is payable within seven (7) business days following the completion of the primary Ophthalmologist surgical procedure.
- 5. This Quotation Estimate does not include costs for emergency Ophthalmologist interventions, hospitalization, or additional surgical procedures that may become necessary based on the treating Ophthalmologist's clinical judgment.
- 6. All Ophthalmologist services are covered under the facility's medical malpractice insurance policy. The client acknowledges that all procedures carry inherent medical risks, and informed consent will be obtained prior to any surgical intervention.
- 7. This Quotation Estimate is non-transferable and is prepared exclusively for the client named above. It does not constitute a binding contract until formally accepted in writing by both parties.
- 8. The Ophthalmologist team in Russia Saint Petersburg reserves the right to modify the treatment plan based on clinical findings. Any such modifications will be communicated to the client in writing, and a revised Quotation Estimate will be issued if additional costs are incurred.
- 9. All personal medical data processed in connection with this Quotation Estimate and subsequent Ophthalmologist treatment will be handled in strict compliance with Federal Law No. 152-FZ "On Personal Data" of the Russian Federation.
- 10. Disputes arising from this Quotation Estimate shall be resolved in accordance with the civil legislation of the Russian Federation, with jurisdiction vested in the courts of Saint Petersburg, Russia.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Russia Saint Petersburg, confirms understanding of the scope of work, associated costs, and all terms and conditions outlined herein, and authorizes Neva Vision Medical Center to proceed with the planned ophthalmological care.
For Neva Vision Medical CenterDr. Elena V. Sokolova, Lead Ophthalmologist
Signature: _________________________
Date: _________________________ Client Acknowledgment
Client Full Name: _________________________
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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