Quotation Estimate Ophthalmologist in South Africa Johannesburg –Free Word Template Download with AI
Professional Ophthalmologist Services — South Africa Johannesburg
Savanna Eye Care Clinic | 142 Rivonia Road, Sandton, Johannesburg, 2196, South Africa
Quotation No.: QTE-2025-JHB-0487Date Issued: 12 June 2025
Valid Until: 12 July 2025 Prepared For: Mr. Thabo Mokoena
Client ID: CL-2025-3391
Medical Aid: Discovery Health (Ref: DH-88214) Prepared By: Dr. Naledi van der Merwe
Specialty: Ophthalmologist (FCS(ophth)SA)
Contact: +27 (0)11 456 7890
This Quotation Estimate has been prepared by Dr. Naledi van der Merwe, a registered and accredited Ophthalmologist practising in South Africa Johannesburg, specifically at the Savanna Eye Care Clinic in the Sandton district. This document outlines the comprehensive range of ophthalmological services, diagnostic procedures, and therapeutic interventions that have been recommended following the initial consultation conducted on 5 June 2025.
As a specialist Ophthalmologist operating within the greater South Africa Johannesburg metropolitan area, our clinic is equipped with state-of-the-art diagnostic technology, including optical coherence tomography (OCT), anterior segment imaging, visual field perimetry, and advanced phacoemulsification surgical suites. This Quotation Estimate reflects the current fee schedule as approved by the Medical Scheme Council of South Africa and is subject to the terms and conditions outlined in Section 6 of this document.
| Item No. | Description of Service | Quantity | Unit Price (ZAR) | Total (ZAR) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & History Review | 1 | R 1,850.00 | R 1,850.00 |
| 02 | Dilated Fundus Examination with OCT Imaging (Bilateral) | 2 | R 920.00 | R 1,840.00 |
| 03 | Automated Refractive Assessment & Keratometry | 1 | R 650.00 | R 650.00 |
| 04 | Anterior Segment Biometry (IOL Calculation for Cataract Surgery) | 1 | R 1,200.00 | R 1,200.00 |
| 05 | Phacoemulsification Cataract Surgery (Right Eye) with Premium Toric IOL | 1 | R 18,500.00 | R 18,500.00 |
| 06 | Post-Operative Ophthalmologist Follow-Up Visits (Week 1, Week 4, Month 3) | 3 | R 750.00 | R 2,250.00 |
| 07 | Prescription of Post-Operative Medication (Antibiotic & Anti-inflammatory Drops) | 1 | R 480.00 | R 480.00 |
| 08 | Prescription of Corrective Spectacles (Post-Surgical, Single Vision) | 1 | R 2,350.00 | R 2,350.00 |
| 09 | Visual Field Perimetry (Humphrey 30-2, Bilateral) | 2 | R 580.00 | R 1,160.00 |
| 10 | Urgent Ophthalmologist Review (If Required Within 6 Months) | 1 | R 1,100.00 | R 1,100.00 |
| SUBTOTAL (All Services) | R 31,380.00 | |||
| VAT @ 15% (Applicable to Private Services) | R 4,707.00 | |||
| GRAND TOTAL (Incl. VAT) | R 36,087.00 | |||
This Quotation Estimate has been structured to align with the standard benefit schedules of major South African medical aid schemes, including Discovery Health, Medihelp, Bonitas, and Momentum Metropolitan. As a registered Ophthalmologist in South Africa Johannesburg, our clinic is a preferred provider for most panel and non-panel schemes. The client is advised to submit this quotation to their medical aid administrator for pre-authorisation prior to the scheduled surgical date.
Where the medical aid benefit does not fully cover the premium toric intraocular lens (IOL) specified in Item 05, the client will be responsible for the difference. Our billing team in Johannesburg will liaise directly with the client's medical aid to confirm the exact co-payment amount. A 50% deposit is required to secure the surgical slot, with the balance payable within 30 days of the procedure.
Dr. Naledi van der Merwe holds a Fellowship of the College of Ophthalmologists of South Africa (FCS(ophth)SA) and has performed over 4,200 cataract surgeries in her career. The Savanna Eye Care Clinic in Sandton, Johannesburg, is a fully accredited surgical facility compliant with the South African Health Professions Council (HPCSA) regulations and the National Health Act. All surgical instruments are sterilised in accordance with South African National Standards (SANS), and the facility undergoes quarterly audits by the South African Health Regulator (SAHPRA).
This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Prices are quoted in South African Rand (ZAR) and are subject to change should the South African Reserve Bank experience significant currency fluctuations affecting imported surgical consumables. Acceptance of this quotation constitutes agreement to all terms and conditions set forth herein.
Terms and Conditions:1. This Quotation Estimate is non-transferable and is issued exclusively to the named client.
2. The Ophthalmologist reserves the right to modify the surgical plan intra-operatively if clinical findings necessitate an alternative approach.
3. All services are rendered in compliance with the Health Professions Act 56 of 1974 (South Africa).
4. Cancellations within 48 hours of a scheduled procedure will incur a 25% administrative fee.
5. This document does not constitute a guarantee of specific visual outcomes. The Ophthalmologist will provide informed consent documentation prior to any surgical intervention.
6. Disputes shall be resolved in the courts of South Africa, Johannesburg Division.
By signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for the ophthalmological services described herein, provided by the undersigned Ophthalmologist at the clinic located in South Africa Johannesburg.
Client Signature:Mr. Thabo Mokoena
Date: ______________________ Ophthalmologist / Authorising Practitioner:
Dr. Naledi van der Merwe, FCS(ophth)SA
HPCSA No: 00458721
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT