GoGPT GoSearch New DOC New XLS New PPT

OffiDocs favicon

Quotation Estimate Ophthalmologist in Sri Lanka Colombo –Free Word Template Download with AI

Professional Ophthalmologist Services — Sri Lanka Colombo

Ref: QTE/OPH/2025/00472  |  Date: 15 June 2025

Prepared By:
Dr. Nimal Perera, MD (Ophthalmology)
Colombo Vision & Eye Care Centre
42, Galle Road, Colombo 03
Sri Lanka
Tel: +94 11 234 5678
Email: [email protected]
Prepared For:
Mr. Sanjaya Wickramasinghe
18, Temple Road, Colombo 07
Sri Lanka
Tel: +94 77 890 1234
Email: [email protected]

This Quotation Estimate is issued by the Colombo Vision & Eye Care Centre, a registered and licensed ophthalmology practice located in the heart of Sri Lanka Colombo, to provide a comprehensive and transparent breakdown of all anticipated costs associated with the full-spectrum ophthalmologist services requested by the client. This document serves as a formal Quotation Estimate for the complete diagnostic, therapeutic, and surgical ophthalmology care package. All pricing is quoted in Sri Lankan Rupees (LKR) and reflects the current fee structure of our Ophthalmologist team as of the date of issue. The Quotation Estimate covers all consultations, diagnostic imaging, surgical procedures, post-operative care, and follow-up appointments conducted by our senior Ophthalmologist and supporting clinical staff at our Sri Lanka Colombo facility.

The following Quotation Estimate encompasses the complete range of Ophthalmologist services to be delivered at our Sri Lanka Colombo clinic. Our Ophthalmologist, Dr. Nimal Perera, holds over twenty years of clinical experience in anterior and posterior segment eye surgery, refractive correction, and management of complex ocular pathologies. The services outlined below represent a comprehensive ophthalmology care pathway tailored to the client's specific clinical needs as identified during the initial assessment.

No. Service Description Quantity Unit Price (LKR) Total (LKR)
1 Initial Ophthalmologist Consultation & Comprehensive Eye Examination (visual acuity, refraction, intraocular pressure, slit-lamp biomicroscopy, fundoscopy) 1 session 8,500 8,500
2 Advanced Diagnostic Imaging — Optical Coherence Tomography (OCT), Fundus Fluorescein Angiography, and B-Scan Ultrasound 1 package 24,000 24,000
3 Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implantation (per eye, bilateral) 2 eyes 185,000 370,000
4 Pre-operative Laboratory Workup (complete blood count, coagulation profile, ECG, chest X-ray, and anaesthetic assessment) 1 package 12,500 12,500
5 Post-operative Ophthalmologist Follow-up Visits (Day 1, Day 7, Week 4, and Month 3 reviews including suture check and IOP monitoring) 4 visits 5,000 20,000
6 Prescription Medications & Topical Eye Drops (antibiotic, anti-inflammatory, and lubricating drops for 30-day post-operative regimen) 1 set 9,800 9,800
7 Custom Prescription Spectacle Lenses (progressive multifocal, anti-reflective coating, UV-400 protection) 1 pair 32,000 32,000
8 Annual Comprehensive Ophthalmologist Health Check-up (next 12 months, including retinal screening and glaucoma surveillance) 1 year 15,000 15,000
Subtotal: 491,800
VAT (18%): 88,524
Grand Total (LKR): 580,324
  • This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Beyond this period, the Ophthalmologist service fees and material costs may be subject to revision based on prevailing market conditions in Sri Lanka Colombo.
  • All surgical procedures will be performed by the senior Ophthalmologist, Dr. Nimal Perera, or a designated consultant ophthalmologist of equivalent seniority at the Colombo Vision & Eye Care Centre facility.
  • A 50% advance payment of the total Quotation Estimate amount is required to confirm the surgical booking and reserve the operating theatre slot. The remaining balance is due within seven (7) days of the final post-operative visit.
  • Any additional diagnostic tests, emergency interventions, or extended hospitalization not explicitly listed in this Quotation Estimate will be communicated to the client in writing prior to commencement, with a supplementary Quotation Estimate issued for approval.
  • The Ophthalmologist and the Sri Lanka Colombo facility maintain full medical malpractice insurance coverage. All surgical instruments and implants are sourced from internationally certified manufacturers and comply with Sri Lankan Medical Device Regulatory Authority (MDRA) standards.
  • Confidentiality of all patient records, diagnostic images, and clinical data is maintained in strict accordance with the Sri Lankan Data Protection Act and the ethical code of the Sri Lanka College of Ophthalmologists.
  • This Quotation Estimate does not constitute a guarantee of specific surgical outcomes. The Ophthalmologist will discuss all potential risks, benefits, and alternative treatment options during the pre-operative counselling session.
Note: This Quotation Estimate is prepared exclusively for the named client and is non-transferable. The Colombo Vision & Eye Care Centre reserves the right to modify the scope of Ophthalmologist services should the clinical presentation change following the initial diagnostic workup. Any such modifications will be documented in a revised Quotation Estimate with the client's written consent.

By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services at the Sri Lanka Colombo facility and agrees to the terms, conditions, and pricing outlined herein. The client confirms that all information provided by the Ophthalmologist regarding the proposed treatment plan, associated risks, and expected recovery timeline has been understood and accepted.

Client Signature
Name: Sanjaya Wickramasinghe
Date: _______________
Ophthalmologist / Authorized Signatory
Name: Dr. Nimal Perera, MD
Colombo Vision & Eye Care Centre, Sri Lanka Colombo
Date: _______________

Colombo Vision & Eye Care Centre — 42, Galle Road, Colombo 03, Sri Lanka
Registered with the Sri Lanka Medical Council | Sri Lanka College of Ophthalmologists Member
This Quotation Estimate is a controlled document. Unauthorized reproduction or distribution is prohibited.
Document Ref: QTE/OPH/2025/00472  |  Page 1 of 1

⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT
×
Advertisement
❤️Shop, book, or buy here — no cost, helps keep services free.