Quotation Estimate Ophthalmologist in United Kingdom Manchester –Free Word Template Download with AI

Quotation Reference: QTE-MAN-2025-04872
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days) Prepared For:
Mr. James R. Whitfield
45 Coronation Road
Salford, Manchester, M5 3AB
United Kingdom
NHS Number: 485 777 3456

This Quotation Estimate has been prepared by Manchester Vision & Eye Care Centre, a fully accredited ophthalmology practice located in the heart of Manchester, United Kingdom. We are pleased to provide you with a detailed and transparent estimate for the comprehensive ophthalmologist services outlined below. Our team of GMC-registered ophthalmologists and specialist optometrists are committed to delivering the highest standard of eye care in the Manchester region and across the United Kingdom.

This Quotation Estimate covers a full diagnostic and therapeutic ophthalmology pathway, including initial consultation, advanced diagnostic imaging, surgical planning, and post-operative follow-up care. All services are delivered in accordance with the standards set by the General Medical Council (GMC), the Care Quality Commission (CQC), and the Royal College of Ophthalmologists.

Ref	Description of Ophthalmologist Service	Quantity	Unit Price (GBP)	Total (GBP)
01	Initial Ophthalmologist Consultation & Comprehensive Eye Examination (including visual acuity testing, intraocular pressure measurement, and slit-lamp biomicroscopy)	1 session	£185.00	£185.00
02	Advanced Diagnostic Imaging – Optical Coherence Tomography (OCT) of the retina and optic nerve, both eyes	2 eyes	£95.00	£190.00
03	Dilated Fundus Examination with Fluorescein Fundus Photography (both eyes)	2 eyes	£75.00	£150.00
04	Corneal Topography and Pachymetry Assessment (both eyes)	2 eyes	£65.00	£130.00
05	Visual Field Testing – Humphrey Perimetry (both eyes)	2 eyes	£80.00	£160.00
06	Cataract Surgical Planning Session with Senior Ophthalmologist (including biometry, IOL calculation, and surgical consent discussion)	1 session	£250.00	£250.00
07	Phacoemulsification Cataract Surgery with Premium Toric Intraocular Lens Implant (one eye)	1 eye	£3,200.00	£3,200.00
08	Post-Operative Ophthalmologist Follow-Up Appointments (Day 1, Week 1, Month 1, Month 3)	4 visits	£55.00	£220.00
09	Prescription of Post-Operative Medication (antibiotic and anti-inflammatory eye drops, 4-week supply)	1 course	£45.00	£45.00
10	Comprehensive Written Ophthalmologist Report and Surgical Documentation for NHS GP Records	1 report	£75.00	£75.00
Subtotal (Excluding VAT):				£4,705.00
VAT (20%):				£941.00
TOTAL ESTIMATED COST (Including VAT):				£5,646.00

Note: Certain NHS-funded ophthalmologist services may be available at reduced or no cost. This Quotation Estimate reflects private ophthalmology care in Manchester, United Kingdom. Please contact our practice to discuss NHS eligibility and potential cost adjustments.

Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision due to changes in medical supply costs, staffing, or regulatory requirements within the United Kingdom.
Payment Terms: A deposit of 25% of the total estimated cost is required to secure your ophthalmologist appointment and surgical slot. The remaining balance is due within fourteen (14) days of the final post-operative follow-up visit. Payment may be made by bank transfer, debit/credit card, or direct debit. We accept all major payment methods standard in the United Kingdom.
Scope of Estimate: This Quotation Estimate is a good-faith projection based on the clinical information available at the time of preparation. Should the ophthalmologist identify additional conditions or complications during the diagnostic or surgical process that were not anticipated, a supplementary Quotation Estimate will be issued and your written consent will be obtained before any additional procedures are performed.
Cancellation Policy: Cancellations made more than fourteen (14) days before the scheduled ophthalmologist appointment will incur no charge. Cancellations within fourteen days will be subject to a 50% fee of the deposit. Cancellations within seventy-two (72) hours will forfeit the full deposit.
Regulatory Compliance: All ophthalmologist services provided by Manchester Vision & Eye Care Centre are fully regulated by the Care Quality Commission (CQC) and the General Medical Council (GMC). Our practice holds full medical indemnity insurance through the Medical Defence Union (MDU) and the Medical Protection Society (MPS).
Data Protection: All patient data collected in connection with this Quotation Estimate and subsequent ophthalmologist care will be processed in strict compliance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.
Complaints: In the event of any dissatisfaction with the ophthalmologist services provided, please contact our Practice Manager in writing. We are committed to resolving all concerns promptly and in accordance with the NHS Complaints Procedure and the Local Ombudsman Service for Manchester, United Kingdom.

By signing below, the patient (or their authorised representative) acknowledges that they have read, understood, and accepted the terms and conditions set out in this Quotation Estimate for ophthalmologist services at Manchester Vision & Eye Care Centre, Manchester, United Kingdom. The patient confirms that they have had the opportunity to ask questions regarding the scope, cost, and risks of the proposed ophthalmologist procedures.

Patient / Authorised Representative Signature
Name: ______________________________
Date: ______________________________ Authorised Ophthalmologist – Manchester Vision & Eye Care Centre
Name: Dr. Sarah E. Pemberton, FRCS (Ophth)
GMC No: 7234561
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX

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