Quotation Estimate Optometrist in Canada Vancouver –Free Word Template Download with AI
Professional Optometrist Services — Canada Vancouver
Quotation Estimate No. QTE-2025-0847 Provider: Pacific Vision Optometry ClinicOptometrist: Dr. Sarah Chen, O.D.
Address: 1247 West Georgia Street, Suite 300
Canada Vancouver, BC V6E 1Y2
Phone: (604) 555-0192
Email: [email protected] Client: Mr. James Whitfield
Address: 892 Oakridge Avenue
Canada Vancouver, BC V6B 3K1
Date Issued: June 12, 2025
Valid Until: July 12, 2025
Payment Terms: Net 30 Days
This Quotation Estimate has been prepared by our licensed Optometrist at Pacific Vision Optometry Clinic, located in the heart of Canada Vancouver, to provide Mr. James Whitfield with a comprehensive and transparent breakdown of all anticipated optometric services, diagnostic procedures, and corrective lens prescriptions. This document serves as a formal Quotation Estimate for the full scope of eye care services to be rendered at our Canada Vancouver facility. All pricing reflects current 2025 Canadian dollar (CAD) rates and complies with the regulations set forth by the College of Optometrists of British Columbia.
Our Optometrist, Dr. Sarah Chen, will perform a complete comprehensive eye examination as part of this Quotation Estimate. The services outlined below represent the full clinical pathway from initial consultation through final prescription dispensing. Each item has been carefully selected based on the preliminary assessment conducted during the intake appointment on June 5, 2025, at our Canada Vancouver clinic.
| # | Service / Item Description | Optometrist Provider | Qty | Unit Price (CAD) | Subtotal (CAD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Optometrist Eye Examination (includes visual acuity, refraction, and binocular vision assessment) | Dr. S. Chen, O.D. | 1 | $185.00 | $185.00 |
| 2 | Dilated Fundus Examination with Ophthalmoscopy (retinal health screening) | Dr. S. Chen, O.D. | 1 | $75.00 | $75.00 |
| 3 | Non-Contact Tonometry (intraocular pressure measurement for glaucoma screening) | Dr. S. Chen, O.D. | 1 | $45.00 | $45.00 |
| 4 | Corneal Topography Mapping (digital corneal curvature analysis) | Dr. S. Chen, O.D. | 1 | $120.00 | $120.00 |
| 5 | Optical Coherence Tomography (OCT) of the macula and optic nerve | Dr. S. Chen, O.D. | 1 | $95.00 | $95.00 |
| 6 | Prescription for Bifocal Progressive Lenses (per pair, including lens fabrication) | Optometrist Dispensing Team | 1 | $420.00 | $420.00 |
| 7 | Anti-Reflective, Blue-Light Filtering, and UV Protection Coating (applied to prescription lenses) | Optometrist Dispensing Team | 1 | $85.00 | $85.00 |
| 8 | Follow-Up Fitting Appointment (lens adjustment and visual adaptation check, 2 weeks post-dispensing) | Dr. S. Chen, O.D. | 1 | $55.00 | $55.00 |
| 9 | Annual Eye Health Monitoring Plan (12-month subscription, includes one re-check and priority scheduling in Canada Vancouver) | Dr. S. Chen, O.D. | 1 | $150.00 | $150.00 |
| Subtotal (before tax): | $1,230.00 | ||||
| GST (5%): | $61.50 | ||||
| PST (8%): | $98.40 | ||||
| TOTAL QUOTATION ESTIMATE AMOUNT: | $1,389.90 | ||||
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After July 12, 2025, the Optometrist services and pricing may be subject to revision in accordance with the College of Optometrists of British Columbia fee guidelines.
- Payment: Full payment of the Quotation Estimate total is due within thirty (30) days of the date of service completion. Accepted payment methods include Interac e-Transfer, Visa, Mastercard, and American Express. A 1.5% monthly late fee will apply to overdue balances.
- Insurance: This Quotation Estimate does not include insurance billing. The client is responsible for verifying coverage with their extended health insurance provider. Our Canada Vancouver clinic can provide itemized receipts for reimbursement purposes.
- Cancellations: Appointments must be rescheduled at least 48 hours in advance. A cancellation fee of $50.00 will be charged for last-minute cancellations of Optometrist appointments.
- Warranty: Prescription lenses fabricated under this Quotation Estimate carry a 12-month warranty against manufacturing defects. The Optometrist will re-fabricate defective lenses at no additional cost.
- Privacy: All patient records and Quotation Estimate documents are handled in compliance with the Personal Information Protection Act (PIPA) of British Columbia and the federal Privacy Act of Canada.
- Regulatory Compliance: All Optometrist services are performed in accordance with the Optometrists Act of British Columbia and the standards established by the College of Optometrists of British Columbia, Canada Vancouver chapter.
By signing below, the client acknowledges receipt of this Quotation Estimate for Optometrist services in Canada Vancouver and authorizes Pacific Vision Optometry Clinic to proceed with the outlined clinical and dispensing services. The client confirms that all information provided in this Quotation Estimate has been reviewed and understood.
Client Signature — Mr. James Whitfield
Date: ____________________
Optometrist Signature — Dr. Sarah Chen, O.D.
Date: ____________________
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