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
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.
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 SignatureName: Sanjaya Wickramasinghe
Date: _______________ Ophthalmologist / Authorized Signatory
Name: Dr. Nimal Perera, MD
Colombo Vision & Eye Care Centre, Sri Lanka Colombo
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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