Quotation Estimate Ophthalmologist in United Arab Emirates Dubai –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — United Arab Emirates Dubai
OFFICIAL MEDICAL QUOTATIONAl Noor Vision & Ophthalmology Center
Building 12, Sheikh Zayed Road, DIFC
Dubai, United Arab Emirates
Tel: +971 4 555 8920
Email: [email protected]
DHA License No: DHA-OPH-2024-08831
Prepared For
Client Name: _______________________
Company / Insurance: ___________________
Address: Dubai, United Arab Emirates
Contact: _______________________
Emirates ID / Passport No: ____________
This Quotation Estimate is issued by Al Noor Vision & Ophthalmology Center, a licensed and accredited ophthalmology practice operating in the United Arab Emirates Dubai, to provide a detailed and transparent breakdown of all anticipated costs associated with the full spectrum of Ophthalmologist services requested by the client. This document serves as a formal Quotation Estimate for planning, budgeting, and insurance pre-authorization purposes within the United Arab Emirates Dubai healthcare framework. All pricing reflects the current 2025 fee schedule approved by the Dubai Health Authority (DHA) and is subject to the terms outlined herein.
| Ref | Ophthalmologist Service Description | Qty | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & Initial Eye Examination (including visual acuity, refraction, and slit-lamp biomicroscopy) | 1 | 450.00 | 450.00 |
| 02 | Dilated Fundus Examination by Senior Ophthalmologist (mydriatic drops included) | 1 | 250.00 | 250.00 |
| 03 | Optical Coherence Tomography (OCT) — Macular & Retinal Imaging | 2 | 380.00 | 760.00 |
| 04 | Anterior Segment & Fundus Photography (digital, 6-view set) | 1 | 320.00 | 320.00 |
| 05 | Intraocular Pressure Measurement (Goldmann Applanation Tonometry) & Gonioscopy | 1 | 180.00 | 180.00 |
| 06 | Corneal Topography & Pachymetry (Pentacam or equivalent) | 1 | 420.00 | 420.00 |
| 07 | Visual Field Testing (Humphrey 24-2 or 30-2 Perimetry) | 2 | 350.00 | 700.00 |
| 08 | B-Scan Ultrasonography (Ocular) — for media-obscurant cases | 1 | 300.00 | 300.00 |
| 09 | Fluorescein Fundus Angiography (FFA) — Ophthalmologist-supervised | 1 | 950.00 | 950.00 |
| 10 | Follow-up Ophthalmologist Review (post-investigation, within 30 days) | 2 | 300.00 | 600.00 |
| 11 | Prescription of Corrective Lenses / Contact Lenses (standard single-vision, per pair) | 1 | 550.00 | 550.00 |
| 12 | Written Ophthalmologist Report & Diagnostic Summary (English & Arabic) | 1 | 200.00 | 200.00 |
| GRAND TOTAL (AED) | 5,980.00 | |||
All Ophthalmologist consultations and diagnostic procedures listed in this Quotation Estimate are performed by board-certified Ophthalmologist specialists registered with the Dubai Health Authority (DHA) and the UAE Ministry of Health and Prevention (MOHAP). The facility in United Arab Emirates Dubai is equipped with state-of-the-art diagnostic imaging, surgical suites, and ambulatory care stations. Should the Ophthalmologist determine during the initial examination that additional surgical intervention (e.g., cataract extraction, LASIK, vitreoretinal surgery, or glaucoma filtration) is medically necessary, a separate and supplementary Quotation Estimate will be issued prior to any procedure, in full compliance with UAE medical regulations and patient consent protocols.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Prices are quoted in UAE Dirhams (AED) and are inclusive of all applicable UAE Value Added Tax (VAT) at the prevailing rate of 5%.
- All Ophthalmologist services must be scheduled and completed at the Al Noor Vision & Ophthalmology Center facility located in Dubai, United Arab Emirates. Telemedicine consultations, where permitted by DHA regulations, may be substituted for follow-up visits at the Ophthalmologist's discretion.
- Payment is due in full within fourteen (14) days of the date of this Quotation Estimate, or as per the agreed insurance pre-authorization timeline. Accepted payment methods include bank transfer, credit/debit card, and approved UAE health insurance direct billing.
- This Quotation Estimate does not constitute a binding contract. Final charges may be adjusted if the Ophthalmologist identifies additional clinical findings requiring further investigation or treatment not anticipated at the time of this estimate.
- The client acknowledges that all Ophthalmologist services are subject to the UAE Medical Malpractice Law (Federal Law No. 2 of 2016) and the DHA Patient Rights Charter. A copy of the informed consent form will be provided prior to any invasive procedure.
- Confidentiality of all medical records, imaging data, and diagnostic reports is maintained in accordance with UAE data protection regulations and the DHA Health Information Exchange (HIE) standards.
- This Quotation Estimate may be submitted to the client's health insurance provider in the United Arab Emirates Dubai for pre-authorization. Our billing department will assist with all necessary documentation and communication with the insurer.
- Any cancellation or rescheduling of Ophthalmologist appointments must be communicated at least 24 hours in advance. A no-show or late cancellation fee of AED 200 may apply.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in United Arab Emirates Dubai and agrees to the terms and conditions outlined above. This signature does not obligate the client to proceed with all listed services but confirms that the cost estimate has been reviewed and understood.
Client / Authorized Representative
Name: _______________________
Signature & Date: ____________
Al Noor Vision & Ophthalmology Center
Dr. Ahmed Al Mansoori, MD (Ophthalmology)
Lead Ophthalmologist & Medical Director
DHA License: DHA-OPH-2024-08831
Signature & Date: ____________
Create your own Word template with our GoGPT AI prompt:
GoGPT