Quotation Estimate Optometrist in Brazil Rio de Janeiro –Free Word Template Download with AI
Professional Optometrist Services — Brazil, Rio de Janeiro
Provider: Visão Clara Optometry CenterAddress: Av. Atlântica, 1250 — Copacabana
Rio de Janeiro, RJ — 22070-001 — Brazil
Phone: +55 (21) 3456-7890
Email: [email protected]
CNPJ: 12.345.678/0001-90 Client: [Client Full Name]
Address: [Client Address]
Rio de Janeiro, RJ — [CEP] — Brazil
Phone: [Client Phone]
Email: [Client Email]
CPF: [Client CPF] Quotation Estimate No.: QTE-2025-0487
Date of Issue: 15 June 2025 Valid Until: 15 July 2025 (30 days)
Service Location: Rio de Janeiro, Brazil
This Quotation Estimate document is issued by Visão Clara Optometry Center, a licensed and accredited Optometrist practice operating in Brazil, Rio de Janeiro, to provide the client with a comprehensive, transparent, and itemized breakdown of all professional optometric services, diagnostic procedures, and associated costs. This Quotation Estimate serves as a formal proposal and does not constitute a binding contract until both parties have reviewed, agreed upon, and signed the acceptance section at the end of this document. All pricing is quoted in Brazilian Reais (BRL) and reflects the current market rates for Optometrist services in the metropolitan region of Brazil, Rio de Janeiro as of the date of issue.
The following Optometrist services have been requested and are included in this Quotation Estimate. All procedures will be performed by a board-certified Optometrist (Optometrista) registered with the Conselho de Fisioterapia e Terapia Ocupacional (CREFITO) and the relevant professional regulatory body in Brazil, Rio de Janeiro.
| Item | Service Description | Quantity | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 01 | Comprehensive Eye Examination by a licensed Optometrist, including visual acuity testing, refraction, and binocular vision assessment | 1 session | R$ 450,00 | R$ 450,00 |
| 02 | Slit-Lamp Biomicroscopy Examination for anterior segment evaluation of the eye | 1 session | R$ 280,00 | R$ 280,00 |
| 03 | Dilated Fundus Examination with mydriatic drops for retinal and optic nerve assessment | 1 session | R$ 320,00 | R$ 320,00 |
| 04 | Non-Contact Tonometry (Intraocular Pressure Measurement) for glaucoma screening | 1 session | R$ 180,00 | R$ 180,00 |
| 05 | Corneal Topography and Pachymetry for corneal mapping and thickness measurement | 1 session | R$ 350,00 | R$ 350,00 |
| 06 | Visual Field Perimetry (Automated) for peripheral vision mapping | 1 session | R$ 290,00 | R$ 290,00 |
| 07 | Optical Dispensing Consultation — frame selection, lens prescription, and fitting by the Optometrist | 1 session | R$ 200,00 | R$ 200,00 |
| 08 | Follow-up Consultation (30 days post-examination) for review of results and adjustment of optical correction | 1 session | R$ 250,00 | R$ 250,00 |
| 09 | Digital Eye Health Report — comprehensive written summary of all findings, recommendations, and prescriptions issued by the Optometrist | 1 report | R$ 150,00 | R$ 150,00 |
| TOTAL ESTIMATED COST | R$ 2,670,00 | |||
Important: All services described in this Quotation Estimate will be conducted at our clinic located in the Copacabana district of Rio de Janeiro, Brazil. The Optometrist team operates Monday through Friday, 08:00 to 18:00, and Saturday 08:00 to 12:00. Please note that public holidays in the state of Rio de Janeiro (such as the Carnival period in February/March and the municipal holidays) may affect scheduling. This Quotation Estimate does not include the cost of eyeglass frames, contact lenses, or surgical referrals, which will be quoted separately if required by the Optometrist during the consultation.
Payment for the services outlined in this Quotation Estimate may be made via bank transfer (TED/PIX), credit card (up to 3 installments without interest), or cash. A 50% deposit is required to confirm the appointment with the Optometrist, with the remaining balance due at the conclusion of the final session. All prices are inclusive of ICMS (Imposto sobre Circulação de Mercadorias e Serviços) as applicable in the state of Rio de Janeiro, Brazil.
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision based on market conditions in Brazil, Rio de Janeiro.
- All Optometrist services are subject to the client's prior medical history review and informed consent, in compliance with Brazilian health regulations (Lei nº 13.709/2018 — LGPD) and the professional code of ethics.
- Appointments must be rescheduled at least 24 hours in advance. No-shows or late cancellations may incur a 50% fee of the scheduled Optometrist session.
- This Quotation Estimate does not guarantee specific medical outcomes. The Optometrist will provide the most accurate diagnosis and treatment plan based on clinical findings at the time of examination.
- Any additional procedures recommended by the Optometrist during the examination that are not listed in this document will be communicated to the client in writing before proceeding, with a supplementary Quotation Estimate if applicable.
- All patient data and medical records are handled in strict accordance with Brazilian data protection laws and the confidentiality standards of the Optometrist profession in Brazil, Rio de Janeiro.
By signing below, the client acknowledges that they have read, understood, and accepted all terms, conditions, and pricing details set forth in this Quotation Estimate for Optometrist services to be provided in Brazil, Rio de Janeiro.
Client SignatureName: _________________________
Date: _________________________ Optometrist / Provider Signature
Name: Dr. [Optometrist Name]
CREFITO Registration: _______
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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