Quotation Estimate Ophthalmologist in South Korea Seoul –Free Word Template Download with AI
Seoul Vision & Eye Care Center
42, Teheran-ro, Gangnam-gu, Seoul, South Korea
Tel: +82-2-555-0147 | Email: [email protected]
License No. KR-OPH-2024-08831 | Business Registration: 123-45-67890
Quotation Estimate No.: QTE-2025-SE-0472
Date of Issue: 15 June 2025
Validity Period: 30 days from date of issue
Prepared By: Dr. Min-Ji Park, Lead Ophthalmologist
Prepared For: Mr. James A. Whitfield
Address: 18, Apgujeong-ro 11-gil, Gangnam-gu, Seoul, South Korea
Contact: +82-10-9876-5432
Insurance Provider: NHIS (National Health Insurance Service)
This Quotation Estimate is issued by Seoul Vision & Eye Care Center, a licensed ophthalmology practice located in the heart of South Korea Seoul, to provide a comprehensive and transparent breakdown of all anticipated costs associated with the ophthalmological services requested by the client. This document serves as a formal Quotation Estimate and does not constitute a binding contract until both parties have reviewed, agreed upon, and executed the final service agreement. All pricing in this Quotation Estimate is denominated in South Korean Won (KRW) and is subject to the standard tax regulations of the Republic of Korea.
The following Quotation Estimate covers a full-spectrum ophthalmological consultation and treatment plan prepared by our senior Ophthalmologist, Dr. Min-Ji Park (Board-Certified, Korean Ophthalmological Society), at our clinic in South Korea Seoul. The services include diagnostic imaging, surgical intervention, post-operative care, and follow-up appointments as detailed below.
| No. | Service / Procedure | Ophthalmologist | Qty | Unit Price (KRW) | Subtotal (KRW) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (visual acuity, intraocular pressure, slit-lamp biomicroscopy, retinal assessment) | Dr. Min-Ji Park | 1 | 180,000 | 180,000 |
| 2 | Optical Coherence Tomography (OCT) & Fundus Photography | Dr. Min-Ji Park | 2 | 95,000 | 190,000 |
| 3 | Anterior Segment & Posterior Segment Ultrasound | Dr. Seo-Yeon Kim | 1 | 120,000 | 120,000 |
| 4 | Phacoemulsification Cataract Surgery with Premium Toric IOL Implantation (bilateral) | Dr. Min-Ji Park | 2 | 1,850,000 | 3,700,000 |
| 5 | Pre-operative Blood Work, ECG & Anesthesia Clearance | Dr. Hwan-Chul Lee | 1 | 250,000 | 250,000 |
| 6 | Post-operative Ophthalmologist Follow-up Visits (Week 1, Week 4, Month 3) | Dr. Min-Ji Park | 3 | 80,000 | 240,000 |
| 7 | Prescription Medications (Antibiotic & Anti-inflammatory Eye Drops, 6-week supply) | Pharmacy | 1 | 45,000 | 45,000 |
| 8 | Custom Prescription Spectacles (post-surgical, single-vision, anti-reflective coating) | Optical Dept. | 1 | 320,000 | 320,000 |
| 9 | Emergency Ophthalmologist On-Call Coverage (12-month post-surgical period) | Dr. Min-Ji Park | 1 | 150,000 | 150,000 |
| 10 | Medical Record Translation (Korean to English) & International Health Certificate | Admin | 1 | 60,000 | 60,000 |
| Subtotal (Items 1–10) | 5,305,000 KRW |
| VAT (10% – Republic of Korea Standard Rate) | 530,500 KRW |
| Grand Total | 5,835,500 KRW |
| NHIS Reimbursable Portion (estimated) | (2,120,000 KRW) |
| Client Out-of-Pocket Balance | 3,715,500 KRW |
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, all prices listed herein are subject to revision based on current market rates in South Korea Seoul and any changes in national medical fee schedules.
- The Ophthalmologist named in this document, Dr. Min-Ji Park, is the primary attending physician. In the event of unavoidable absence, a substitute board-certified Ophthalmologist of equivalent or higher seniority will be assigned, and the client will be notified no fewer than 48 hours in advance.
- All surgical procedures will be performed at the Seoul Vision & Eye Care Center operating facility, located at 42 Teheran-ro, Gangnam-gu, South Korea Seoul, in full compliance with the Medical Service Act of the Republic of Korea and the standards set by the Korean Ophthalmological Society.
- Payment of the client out-of-pocket balance is due within fourteen (14) days of the date of this Quotation Estimate acceptance. Accepted payment methods include bank transfer (KRW), credit card (Visa, Mastercard, JCB), and NHIS direct billing. A late payment surcharge of 1.5% per month will apply to outstanding balances.
- The NHIS reimbursement estimate provided in Section 3 is based on the current 2025 fee schedule. Actual reimbursement amounts are determined solely by the National Health Insurance Service and may vary. The client acknowledges that this Quotation Estimate does not guarantee a specific NHIS payout.
- Any additional procedures, medications, or Ophthalmologist consultations not explicitly listed in this Quotation Estimate will be billed separately at the clinic's standard rates, with prior written consent obtained from the client before any such additional service is rendered.
- This Quotation Estimate does not cover pre-existing conditions unrelated to the procedures listed, cosmetic enhancements beyond the medically indicated scope, or hospitalization exceeding three (3) nights unless medically necessitated and pre-approved in writing by the attending Ophthalmologist.
- All medical records, imaging files, and translated documents generated in connection with this engagement will be retained by the clinic in South Korea Seoul for a minimum of ten (10) years in accordance with Korean medical record retention law. The client may request certified copies at any time.
- Disputes arising from this Quotation Estimate or the services described herein shall be resolved through the Seoul Medical Dispute Mediation Committee. If mediation is unsuccessful, the matter shall be subject to the exclusive jurisdiction of the Seoul Central District Court, South Korea Seoul.
- By signing below, the client acknowledges receipt of this Quotation Estimate, confirms that all services, costs, and terms have been explained in a language the client understands, and authorizes the Ophthalmologist and the Seoul Vision & Eye Care Center to proceed with the outlined treatment plan upon full payment of the applicable balance.
For Seoul Vision & Eye Care Center
Dr. Min-Ji Park, M.D., Ph.D.
Lead Ophthalmologist & Director
Korean Ophthalmological Society License No. 2019-OPH-4472
Signature & DateClient / Authorized Representative
Mr. James A. Whitfield
Passport No.: GB-5521-8834
Resident in: Gangnam-gu, Seoul, South Korea
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