Quotation Estimate Ophthalmologist in Tanzania Dar es Salaam –Free Word Template Download with AI

Quotation Estimate No.: QTE-2025-0487
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 Prepared For:
Ms. Amina Hassan Juma
P.O. Box 7890, Kariakoo
Tanzania Dar es Salaam
Tel: +255 754 123 456 1. INTRODUCTION AND SCOPE

This Quotation Estimate is issued by East African Vision & Eye Care Centre, a licensed and accredited ophthalmology practice operating in Tanzania Dar es Salaam, in response to the client's request for a comprehensive ophthalmological assessment and treatment plan. Our Ophthalmologist, Dr. Joseph M. Mwinyi (MBChB, MMed Ophthalmology, FCOphth), has reviewed the preliminary clinical notes and prepared the following detailed estimate for the full spectrum of diagnostic, therapeutic, and follow-up services required. All pricing is quoted in Tanzanian Shillings (TZS) and reflects the current fee schedule of our Ophthalmologist department as of the date of issue.

2. ITEMIZED SERVICES AND PRICING

No.	Service Description	Ophthalmologist / Provider	Qty	Unit Price (TZS)	Total (TZS)
1	Comprehensive Ophthalmologist Consultation & History Review (initial visit, 45 minutes)	Dr. J.M. Mwinyi	1	150,000	150,000
2	Complete Diagnostic Workup: Visual Acuity, Refraction, Intraocular Pressure (Tonometry), Slit-Lamp Biomicroscopy, Fundus Examination, and Visual Field Perimetry	Dr. J.M. Mwinyi & Optometric Team	1	350,000	350,000
3	Anterior Segment & Posterior Segment OCT (Optical Coherence Tomography) Imaging – Bilateral	Imaging Department	2	180,000	360,000
4	Colour Fundus Photography & Wide-Angle Retinal Imaging (30° and 120°)	Imaging Department	1	220,000	220,000
5	Pharmacological Mydriasis & Pupil Dilation (Tropicamide 1% + Phenylephrine 2.5%)	Ophthalmic Nurse	1	45,000	45,000
6	Prescription of Corrective Lenses (Bifocal, Anti-Reflective Coating) – Pair	Optical Dispensary	1	480,000	480,000
7	Topical Medication Supply: Lubricating Eye Drops (Carboxymethylcellulose 0.5%) – 30-day supply	Pharmacy	2	35,000	70,000
8	Follow-up Ophthalmologist Review (6 weeks post-treatment, 30 minutes)	Dr. J.M. Mwinyi	1	120,000	120,000
9	Annual Ophthalmologist Screening & Preventive Eye Health Check (subsequent year)	Dr. J.M. Mwinyi	1	200,000	200,000
10	Transport & Home Visit Fee (within Dar es Salaam city limits, if required)	Clinical Team	1	80,000	80,000
Subtotal					2,075,000
VAT (18% – Tanzania Revenue Authority)					373,500
GRAND TOTAL (TZS)					2,448,500

Note: This Quotation Estimate does not include the cost of any surgical intervention (e.g., cataract extraction, LASIK, or retinal repair) should the Ophthalmologist determine that operative treatment is necessary. A separate, detailed surgical Quotation Estimate will be issued upon clinical confirmation. All services are to be rendered at our facility in Tanzania Dar es Salaam unless otherwise agreed in writing. 3. TERMS AND CONDITIONS

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision based on changes in pharmaceutical costs, equipment maintenance, or regulatory adjustments by the Tanzania Medical Council.
Payment is due within fourteen (14) days of acceptance of this Quotation Estimate. Accepted payment methods include bank transfer to our account at CRDB Bank, Dar es Salaam branch, mobile money (M-Pesa, Tigo Pesa, Airtel Money), and certified cheque.
A 50% deposit is required to schedule the initial Ophthalmologist consultation and diagnostic workup. The remaining balance is payable upon completion of all services listed herein.
All ophthalmological procedures and consultations are performed by a licensed Ophthalmologist registered with the Tanzania Medical Council and the East African Ophthalmological Society. Our practice holds a valid facility licence from the Ministry of Health, Tanzania, for the Dar es Salaam region.
The client acknowledges that the Ophthalmologist reserves the right to modify the treatment plan based on clinical findings during the examination. Any additional services not listed in this Quotation Estimate will be communicated and approved in writing before commencement.
Confidentiality of all patient records, imaging data, and clinical notes is maintained in strict accordance with the Tanzania Data Protection Act, 2022, and the professional ethical code of the East African Ophthalmological Society.
This Quotation Estimate is non-transferable and is issued exclusively for the named client residing in Tanzania Dar es Salaam.
Any disputes arising from the interpretation or execution of this Quotation Estimate shall be resolved through amicable negotiation, failing which the matter shall be referred to the Tanzania Medical Council's disciplinary and arbitration panel in Dar es Salaam.

4. ACCEPTANCE

By signing below, the client confirms acceptance of this Quotation Estimate for the ophthalmological services described above, to be delivered by our Ophthalmologist team at the East African Vision & Eye Care Centre, Tanzania Dar es Salaam. The client further confirms that all terms and conditions have been read, understood, and agreed upon.

For: East African Vision & Eye Care Centre
Dr. Joseph M. Mwinyi – Lead Ophthalmologist
Date: ______________________ Client Acceptance
Ms. Amina Hassan Juma
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX

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