Quotation Estimate Ophthalmologist in Turkey Istanbul –Free Word Template Download with AI
Medina Vision Eye Clinic | Istanbul, Turkey
Address: Büyükdere Caddesi No. 142, 34450 Esenyurt, Istanbul, Turkey
Tel: +90 212 555 0142 | Email: [email protected]
Quotation Estimate No.: QTE-2025-04871Date of Issue: 15 June 2025
Valid Until: 15 September 2025 Prepared For: [Patient / Referring Physician Name]
Referral Source: [Hospital / Insurance Provider]
Country of Origin: [Patient's Home Country]
1. Introduction and Scope of This Quotation Estimate
This Quotation Estimate has been prepared by Medina Vision Eye Clinic, a fully accredited ophthalmology center located in the heart of Turkey Istanbul, to provide a transparent and comprehensive breakdown of all anticipated costs associated with the requested ophthalmological procedures and consultations. As a leading Ophthalmologist practice in Turkey Istanbul, we are committed to delivering world-class eye care while ensuring full financial transparency for every patient. This document serves as a formal Quotation Estimate and does not constitute a binding contract; final billing may vary slightly depending on the clinical findings during the pre-operative assessment conducted by our senior Ophthalmologist.
2. Patient and Referral Details
| Field | Details |
|---|---|
| Patient Full Name | [To be completed upon registration] |
| Date of Birth | [DD/MM/YYYY] |
| Passport / ID Number | [To be provided] |
| Referring Ophthalmologist | [Name and Institution] |
| Diagnosis / Indication | [e.g., Cataract, Refractive Error, Retinal Condition] |
| Insurance / Coverage | [Private / Self-Pay / International Insurance] |
3. Itemized Cost Breakdown – Ophthalmologist Services in Turkey Istanbul
| Item No. | Description of Service | Unit | Quantity | Unit Price (USD) | Total (USD) | |
|---|---|---|---|---|---|---|
| 1 | Initial Consultation with Senior Ophthalmologist (includes full ocular examination, visual acuity testing, and medical history review) | Session | 1 | 150.00 | 150.00 | |
| 2 | Comprehensive Diagnostic Workup (OCT, Fundus Photography, Visual Field Analysis, Biometry, Corneal Topography) | Package | 1 | 420.00 | 420.00 | |
| 3 | Phacoemulsification Cataract Surgery with Premium Toric IOL Implantation (per eye) | Eye | 2 | 1,850.00 | 3,700.00 | |
| 4 | Pre-operative Anesthesia and Sedation (local with IV sedation) | Session | 1 | 200.00 | 200.00 | |
| 5 | Post-operative Follow-up Visits with Ophthalmologist (Day 1, Week 1, Month 1, Month 3) | Visit | 4 | 80.00 | 320.00 | |
| 6 | Prescription Medications (Antibiotic and Anti-inflammatory eye drops, 30-day supply) | Set | 1 | 95.00 | 95.00 | |
| 7 | Post-operative Protective Eyewear and Aftercare Kit | Set | 1 | 60.00 | 60.00 | |
| 8 | Airport Transfer and Accommodation Coordination (5 nights, 4-star hotel in Istanbul) | Package | 1 | 680.00 | 680.00 | |
| 9 | Medical Interpreter and Patient Liaison Services (English / Arabic / Russian) | Package | 1 | 250.00 | 250.00 | |
| 10 | International Medical Report and Discharge Summary (certified, for insurance or visa purposes) | Document | 1 | 75.00 | 75.00 | |
| SUBTOTAL | $6,045.00 | |||||
| Applicable VAT (20% – Turkey Istanbul Standard Rate) | $1,209.00 | |||||
| GRAND TOTAL (Quotation Estimate) | $7,254.00 | |||||
4. Terms and Conditions of This Quotation Estimate
This Quotation Estimate is valid for a period of ninety (90) days from the date of issue. All prices are quoted in United States Dollars (USD) and are inclusive of the Ophthalmologist's professional fees, surgical theatre charges, and standard consumables. The total amount reflects the full scope of ophthalmological care to be delivered at our facility in Turkey Istanbul. Should the Ophthalmologist, during the pre-operative evaluation, identify additional pathology requiring supplementary intervention, a revised Quotation Estimate will be issued and must be approved in writing by the patient or their authorized representative before any additional procedure is performed.
Payment may be arranged in the following manner: a non-refundable deposit of 30% (approximately $2,176.20) is required to secure the surgical date and reserve the Ophthalmologist's schedule. The remaining 70% balance is due within 48 hours of the completion of the final post-operative visit. We accept international wire transfers, major credit cards, and secure online payment gateways. All transactions are processed in compliance with Turkish financial regulations and international data protection standards.
5. Clinical and Administrative Notes
Important: This Quotation Estimate assumes the patient is medically fit for elective ophthalmic surgery. A pre-anesthetic clearance from the patient's primary care physician or cardiologist (dated within 30 days of the procedure) is mandatory. The Ophthalmologist in Turkey Istanbul reserves the right to postpone or modify the surgical plan if intra-operative findings differ from the pre-operative assessment. All surgical procedures are performed in accordance with the Turkish Ministry of Health regulations and the standards set by the Turkish Society of Ophthalmology.Medina Vision Eye Clinic holds full accreditation from the Turkish Ministry of Health and is a member of the International Council of Ophthalmology. Our senior Ophthalmologist team has over 25 years of combined experience in refractive surgery, cataract management, vitreoretinal procedures, and ocular oncology. Patients traveling to Turkey Istanbul for ophthalmic care benefit from our dedicated international patient department, which handles visa medical letters, insurance pre-authorization, and post-discharge follow-up coordination with the patient's home-country Ophthalmologist.
6. Acceptance and Authorization
By signing below, the patient or authorized representative acknowledges receipt of this Quotation Estimate, confirms understanding of the itemized costs for the Ophthalmologist services in Turkey Istanbul, and authorizes the clinic to proceed with scheduling upon receipt of the required deposit. This signature does not constitute a guarantee of a specific surgical outcome but confirms agreement with the financial terms outlined herein.
Patient / Authorized RepresentativeName: _________________________
Date: _________________________
Dr. [Name], MD, FACS
Senior Ophthalmologist & Clinic Director
Date: _________________________
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