Quotation Estimate Ophthalmologist in Saudi Arabia Riyadh –Free Word Template Download with AI
Professional Ophthalmologist Services — Saudi Arabia, Riyadh
REF: QTE-RYD-2025-0417
Practice Name: Al-Nur Vision & Ophthalmology Center
Address: King Fahd Road, Al Olaya District, Riyadh 12212, Saudi Arabia
License No.: MOH-OPH-2019-00847 (Ministry of Health, Kingdom of Saudi Arabia)
Telephone: +966 11 456 7890
Email: [email protected]
VAT Registration No.: 310123456700003
Client Name: [To be filled upon acceptance]
Organization: [Corporate / Individual]
Address: Riyadh, Saudi Arabia
Contact Person: [Name & Title]
Phone / Email: [To be provided]
This Quotation Estimate is issued by Al-Nur Vision & Ophthalmology Center, a licensed and accredited Ophthalmologist practice operating in Riyadh, Saudi Arabia. The following services are included in this estimate and are designed to provide comprehensive, world-class eye care in accordance with the standards set by the Saudi Ministry of Health and the Saudi Food and Drug Authority (SFDA). All procedures will be performed by a board-certified Ophthalmologist with over fifteen years of clinical experience in the Kingdom of Saudi Arabia.
| # | Service / Procedure | Description | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation | Full eye examination including visual acuity, refraction, intraocular pressure, and slit-lamp biomicroscopy | 2 | 450.00 | 900.00 |
| 2 | Dilated Fundus Examination | Retinal and optic nerve assessment using mydriatic agents; performed by the Ophthalmologist | 2 | 250.00 | 500.00 |
| 3 | Optical Coherence Tomography (OCT) | High-resolution cross-sectional imaging of the retina and macula | 2 | 350.00 | 700.00 |
| 4 | Corneal Topography & Pachymetry | Mapping of corneal curvature and thickness measurement | 1 | 300.00 | 300.00 |
| 5 | Visual Field Testing (Humphrey Perimetry) | Automated perimetry for glaucoma screening and monitoring | 2 | 280.00 | 560.00 |
| 6 | Anterior Segment Photography | Digital documentation of ocular structures for the Ophthalmologist's records | 2 | 150.00 | 300.00 |
| 7 | Prescription of Corrective Lenses (if applicable) | Single-vision or progressive lenses, standard frame included | 1 | 1,200.00 | 1,200.00 |
| 8 | Follow-Up Ophthalmologist Visit (30 days) | Post-examination review, treatment plan adjustment, and progress assessment | 1 | 350.00 | 350.00 |
| 9 | Pharmacological Treatment (if prescribed) | Topical eye drops, oral medications as directed by the Ophthalmologist | 1 | 400.00 | 400.00 |
| 10 | Administrative & Documentation Fee | Medical report preparation, insurance coordination, and record filing in Riyadh | 1 | 100.00 | 100.00 |
| Subtotal | 5,310.00 | ||||
| VAT (15%) | 796.50 | ||||
| GRAND TOTAL | 6,106.50 | ||||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision based on current market rates in Saudi Arabia, Riyadh.
- All services listed herein will be delivered by a licensed Ophthalmologist or under the direct supervision of the Ophthalmologist at our facility in Riyadh, Saudi Arabia.
- Payment is due within fourteen (14) days of the acceptance of this Quotation Estimate. Accepted payment methods include bank transfer (STC Pay, Mada), credit/debit card, and cash at the clinic.
- A 50% advance payment is required to secure the appointment schedule. The remaining balance shall be settled upon completion of all services.
- This estimate does not include emergency surgical interventions, laser procedures (e.g., LASIK, YAG capsulotomy), or intraocular surgery unless explicitly added as a supplementary line item with written client approval.
- All medical records and diagnostic imaging will be stored in compliance with the Saudi Data and AI Authority (SDAIA) regulations and the Ministry of Health data protection guidelines.
- The Ophthalmologist reserves the right to modify the treatment plan based on clinical findings during the examination. Any additional procedures will be communicated to the client prior to execution and will be billed separately.
- This Quotation Estimate is non-transferable and is issued exclusively for the named client in Riyadh, Saudi Arabia.
- Any disputes arising from this estimate shall be governed by the laws of the Kingdom of Saudi Arabia and shall be subject to the jurisdiction of the courts in Riyadh.
- Insurance coverage: This estimate may be submitted to the client's health insurance provider (e.g., Bupa, Tawuniya, MedGulf) for pre-authorization. The client is responsible for any co-pay or non-covered amounts.
By signing below, the client acknowledges and accepts the terms, conditions, and pricing outlined in this Quotation Estimate for Ophthalmologist services provided in Riyadh, Saudi Arabia. The undersigned authorizes Al-Nur Vision & Ophthalmology Center to proceed with the scheduled examinations and treatments as described herein.
Client SignatureName: _________________________
Date: _________________________ Ophthalmologist / Provider
Dr. Khalid Al-Rashid, MD, FACS
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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