Quotation Estimate Ophthalmologist in United Kingdom London –Free Word Template Download with AI
Thames Vision Ophthalmology Centre
142 Harley Street, Marylebone, London, W1G 8AP, United Kingdom
Telephone: +44 (0)20 7946 0832 | Email: [email protected]
Registered in England & Wales No. 09876543 | GMC Registered Practitioners
1. Introduction and Scope of Services
This Quotation Estimate has been prepared by Thames Vision Ophthalmology Centre, a specialist Ophthalmologist practice located in the heart of United Kingdom London, to provide Mr. James A. Whitfield with a detailed and transparent breakdown of the anticipated costs associated with a full diagnostic and therapeutic ophthalmic programme. As a registered Ophthalmologist clinic operating under the regulatory oversight of the General Medical Council (GMC) and the Care Quality Commission (CQC) within the United Kingdom London metropolitan area, we are committed to delivering the highest standard of eye care in accordance with the Royal College of Ophthalmologists' clinical guidelines.
The services outlined in this Quotation Estimate encompass a comprehensive ophthalmic assessment, advanced diagnostic imaging, and a tailored treatment plan. All clinical procedures will be performed by a consultant Ophthalmologist or a senior ophthalmic registrar under direct supervision, in full compliance with the NHS England and London Health Board standards for private ophthalmic care.
2. Itemised Services and Pricing
| Ref. | Description of Ophthalmologist Service | Unit | Unit Price (GBP) | Total (GBP) |
|---|---|---|---|---|
| 01 | Initial Consultation with Consultant Ophthalmologist – Full history, visual acuity testing, anterior segment examination, and preliminary diagnosis | 1 session | £185.00 | £185.00 |
| 02 | Comprehensive Dilated Fundus Examination – Retinal assessment, optic nerve evaluation, and peripheral retinal mapping by the Ophthalmologist | 1 session | £120.00 | £120.00 |
| 03 | Optical Coherence Tomography (OCT) – High-resolution cross-sectional imaging of the retina and macula | 2 scans | £95.00 | £190.00 |
| 04 | Automated Perimetry (Humphrey Visual Field Test) – 24-2 and 30-2 protocols to assess peripheral and central visual fields | 2 tests | £85.00 | £170.00 |
| 05 | Anterior Segment Biometry and Corneal Topography – IOL power calculation and corneal curvature mapping for surgical planning | 1 session | £110.00 | £110.00 |
| 06 | Phacoemulsification Cataract Surgery (per eye) – Performed by Consultant Ophthalmologist with premium multifocal intraocular lens implantation | 2 eyes | £3,200.00 | £6,400.00 |
| 07 | Post-Operative Review – Three follow-up appointments with the Ophthalmologist at 1 week, 1 month, and 3 months post-surgery | 3 visits | £75.00 | £225.00 |
| 08 | Prescription of Post-Operative Medication – Topical antibiotics, anti-inflammatory drops, and mydriatic agents (30-day supply) | 1 course | £65.00 | £65.00 |
| 09 | Annual Ophthalmologist Surveillance – Yearly retinal screening and IOL position check for the first two years post-procedure | 2 years | £140.00 | £280.00 |
| Subtotal (Excluding VAT): | £8,745.00 | |||
| VAT (20%): | £1,749.00 | |||
| Grand Total (Including VAT): | £10,494.00 | |||
* Note: Certain NHS-regulated diagnostic services may be exempt from VAT under UK HMRC regulations. The VAT charge above is applied to the full private fee as a precautionary estimate. Final VAT treatment will be confirmed at the point of invoicing by our Ophthalmologist billing team in London.
3. Terms and Conditions of This Quotation Estimate
- Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Should the quotation expire, the Ophthalmologist practice reserves the right to revise pricing in line with current London healthcare market rates.
- Payment Schedule: A deposit of 25% (£2,623.50) is required to secure the surgical date with the Ophthalmologist. The remaining balance of 75% is due within fourteen (14) days of the final post-operative review. Payment may be made by bank transfer, credit/debit card, or direct debit. Instalment plans of up to six monthly payments are available upon request.
- Cancellation Policy: Cancellations made more than fourteen (14) days prior to the scheduled procedure will incur no charge. Cancellations between seven (7) and fourteen (14) days will be subject to a 50% fee. Cancellations within seven (7) days will be charged in full. This policy applies to all Ophthalmologist appointments booked through this Quotation Estimate.
- Medical Fitness: The Ophthalmologist reserves the right to defer or cancel any surgical procedure if, upon pre-operative assessment, the patient is deemed medically unfit. In such cases, the deposit will be refunded in full and no further charges will apply.
- Complaints and Disputes: Any concerns regarding the services described in this Quotation Estimate should be directed to the Practice Manager at Thames Vision Ophthalmology Centre, London. Formal complaints will be handled in accordance with the London Health Board's private sector complaints protocol and the NHS Resolution framework.
- Confidentiality: All patient data processed under this Quotation Estimate is handled in strict compliance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. Clinical records are stored securely at our London premises and are accessible only to the treating Ophthalmologist team.
- Governing Law: This Quotation Estimate and all associated services are governed by the laws of England and Wales, with jurisdiction vested in the courts of United Kingdom London.
4. Acceptance and Authorisation
By signing below, the patient acknowledges that they have read, understood, and accepted all terms set out in this Quotation Estimate for Ophthalmologist services provided in United Kingdom London. The patient confirms that they have had the opportunity to seek independent medical advice and that the information provided by the Ophthalmologist is sufficient for informed consent.
Patient / Authorised Representative:
Name: Mr. James A. WhitfieldSignature: ______________________________
Date: ______________________________
Thames Vision Ophthalmology Centre (Ophthalmologist Practice):
Name: Dr. Sarah M. Chen, MBChB, FRCS (Ophth)Consultant Ophthalmologist
Signature: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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