Quotation Estimate Ophthalmologist in Singapore Singapore –Free Word Template Download with AI
ClearVision Ophthalmology Centre
128 Orchard Road, Level 5, Singapore Singapore 238849
Tel: +65 6823 4567 | Email: [email protected]
UEN: 201934567K | HSA Licensed Ophthalmologist Practice
This Quotation Estimate is issued by ClearVision Ophthalmology Centre, a fully licensed and accredited ophthalmic practice operating in Singapore Singapore, to provide a comprehensive and transparent breakdown of all anticipated costs associated with the ophthalmological care and treatment of the above-named patient. Our senior Ophthalmologist, Dr. Lim Siew Hua (MOH-registered, FRCS Ophth, FRCOphth), will oversee the entire course of treatment from initial diagnostic assessment through to post-operative follow-up. This Quotation Estimate reflects the prevailing medical fee schedule in Singapore Singapore as of the date of issue and is subject to the terms and conditions outlined herein.
| No. | Description of Ophthalmologist Service | Unit | Rate (SGD) | Amount (SGD) |
|---|---|---|---|---|
| 1 | Initial Consultation with Senior Ophthalmologist – Comprehensive eye examination including visual acuity testing, refraction, slit-lamp biomicroscopy, and intraocular pressure measurement | 1 session | 380.00 | 380.00 |
| 2 | Advanced Diagnostic Imaging – Optical Coherence Tomography (OCT), Fundus Fluorescein Angiography (FFA), and Anterior Segment OCT performed by the Ophthalmologist's team | 1 package | 650.00 | 650.00 |
| 3 | Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implant – Performed by the Lead Ophthalmologist in a Singapore Singapore accredited surgical facility | 1 eye | 4,850.00 | 4,850.00 |
| 4 | Pre-operative Medical Clearance and Anaesthetic Assessment – Coordinated by the Ophthalmologist with anaesthesiology team | 1 session | 220.00 | 220.00 |
| 5 | Post-operative Follow-up Visits with the Ophthalmologist – Includes Day 1, Week 1, Week 4, and Month 3 reviews with suture removal if applicable | 4 visits | 180.00 | 720.00 |
| 6 | Prescription Medications – Topical antibiotic and anti-inflammatory eye drops (30-day supply), prescribed by the Ophthalmologist | 1 course | 145.00 | 145.00 |
| 7 | Emergency Post-operative Consultation – Available 24/7 at our Singapore Singapore clinic for any urgent ophthalmic concerns managed by the Ophthalmologist on call | 1 visit | 250.00 | 250.00 |
| 8 | Administrative and Facility Fees – Covers theatre usage, nursing care, and documentation within the Singapore Singapore healthcare framework | 1 package | 480.00 | 480.00 |
| TOTAL ESTIMATED COST (SGD) | 7,695.00 | |||
3.1 A deposit of 50% (SGD 3,847.50) of the total Quotation Estimate amount is required upon acceptance to secure the surgical slot with the Ophthalmologist. The remaining balance shall be settled within 14 calendar days following the completion of the final post-operative visit.
3.2 Payment may be made via bank transfer, credit card (Visa, Mastercard, Amex), or PayNow. All transactions are processed in accordance with the regulations of the Monetary Authority of Singapore Singapore.
3.3 This Quotation Estimate is valid for 30 days from the date of issue. Should the patient require to defer the procedure beyond this period, the Quotation Estimate shall be reissued to reflect any changes in the Ophthalmologist's fee schedule or prevailing Singapore Singapore medical cost indices.
3.4 Any additional procedures, complications, or extended hospitalisation not foreseen at the time of this Quotation Estimate will be communicated to the patient in writing by the Ophthalmologist prior to commencement, with a supplementary Quotation Estimate provided for approval.
3.5 This Quotation Estimate does not include costs for pre-existing conditions unrelated to the primary ophthalmic procedure, nor does it cover accommodation, meals, or transport within Singapore Singapore.
I, Dr. Lim Siew Hua, hereby confirm that this Quotation Estimate accurately reflects the standard of care and treatment plan I, as a registered Ophthalmologist in Singapore Singapore, intend to provide to the patient named above. All procedures described herein will be performed in strict adherence to the Singapore Medical Council's Code of Ethics and Professional Conduct, as well as the clinical guidelines issued by the Singapore Academy of Ophthalmology. The Ophthalmologist reserves the right to modify the treatment plan intra-operatively if clinical findings necessitate a deviation from the originally proposed procedure, and such modifications will be documented and communicated to the patient or their authorised representative.
Important Note: This Quotation Estimate is a good-faith estimate of costs and does not constitute a fixed-price guarantee. Actual charges may vary slightly depending on the complexity of the case as assessed by the Ophthalmologist during the procedure. All services are subject to the availability of the Ophthalmologist and the surgical facilities in Singapore Singapore. Patients are advised to verify coverage with their respective insurance providers or MediSave/MediShield Life plans before proceeding.By signing below, the patient (or authorised legal representative) acknowledges having received, read, and understood this Quotation Estimate in full. The patient confirms that the Ophthalmologist has explained the nature, risks, benefits, and alternatives of the proposed ophthalmic procedure in a manner the patient finds satisfactory. The patient authorises the Ophthalmologist and the ClearVision Ophthalmology Centre team to proceed with the treatment as outlined in this Quotation Estimate.
Patient / Authorised RepresentativeName: _________________________
Signature: _________________________
Date: _________________________ Ophthalmologist / Practice Director
Name: Dr. Lim Siew Hua
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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