Quotation Estimate Optometrist in India Mumbai –Free Word Template Download with AI
ClearSight Optometry Centre
42, Linking Road, Bandra West, Mumbai, Maharashtra – 400050, India
Phone: +91-22-4055-6789 | Email: [email protected]
Reg. No.: MH/OPT/2019/00482 | GSTIN: 27AABCU1234F1Z5
Client / Recipient Details| Client Name: | Mr. Rajesh Kumar Sharma |
| Address: | 18, Panchavati Society, Andheri East, Mumbai, Maharashtra – 400069, India |
| Contact: | +91-98200-12345 | [email protected] |
| Reference / Enquiry No.: | ENQ/2025/0321 |
This Quotation Estimate is issued by ClearSight Optometry Centre, a registered and licensed Optometrist practice operating in India Mumbai, in response to the client's request for a comprehensive vision assessment and corrective eyewear solution. The following services and products have been evaluated and are hereby quoted for the client's consideration. All clinical procedures will be performed by a qualified Optometrist holding a valid registration with the Maharashtra State Council of Optometry and are conducted in accordance with the standards set by the Indian Council of Medical Research (ICMR) and the National Health Mission guidelines applicable in India Mumbai.
Itemized Quotation Estimate Breakdown| Sr. No. | Service / Product Description | Qty | Unit Price (INR) | Amount (INR) |
|---|---|---|---|---|
| 1 | Comprehensive Optometrist Consultation & Visual Acuity Assessment (including manifest and latent refraction) | 1 | 1,500.00 | 1,500.00 |
| 2 | Autorefraction & Subjective Refinement by Senior Optometrist | 1 | 800.00 | 800.00 |
| 3 | Slit Lamp Biomicroscopy & Anterior Segment Examination | 1 | 1,200.00 | 1,200.00 |
| 4 | Dilated Fundus Examination with Direct & Indirect Ophthalmoscopy | 1 | 1,000.00 | 1,000.00 |
| 5 | Corneal Topography (Tonometer) & Pachymetry Reading | 1 | 1,800.00 | 1,800.00 |
| 6 | Binocular Vision & Ocular Motility Assessment (Hirschberg, Cover Test, Phoria Measurement) | 1 | 900.00 | 900.00 |
| 7 | Intraocular Pressure Measurement (Non-Contact Tonometer) | 1 | 500.00 | 500.00 |
| 8 | Prescription of Custom-Designed Progressive Lenses (1.67 Index, Anti-Reflective & Blue-Light Filter Coating) | 2 | 8,500.00 | 17,000.00 |
| 9 | Frame – Titanium Alloy, Semi-Rimless (Designer Collection, India Mumbai exclusive stock) | 1 | 6,500.00 | 6,500.00 |
| 10 | Lens Fitting, Dispensing, and Post-Dispensing Follow-up (2 visits within 30 days) | 1 | 1,000.00 | 1,000.00 |
| 11 | Annual Eye Health Check-up Package (valid for 12 months, includes 2 Optometrist reviews) | 1 | 3,500.00 | 3,500.00 |
| Subtotal (INR) | 35,700.00 | |||
| GST @ 18% (as applicable in India Mumbai) | 6,426.00 | |||
| Grand Total (INR) | 42,126.00 | |||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, the Optometrist services and product pricing may be revised based on prevailing market rates in India Mumbai.
- All prices quoted are in Indian Rupees (INR) and are subject to the Goods and Services Tax (GST) at the applicable rate of 18% as mandated by the Government of India for optical services and products.
- Payment is due within seven (7) days of acceptance of this Quotation Estimate. Accepted modes of payment include NEFT/RTGS, UPI, debit/credit cards, and bank transfer to the account of ClearSight Optometry Centre, Mumbai.
- The Optometrist services described herein will be performed by Dr. Ananya Deshmukh (Reg. No. MH-OPT-2014-0091) or a duly qualified associate Optometrist under her supervision at our India Mumbai facility.
- Custom lenses and frames, once ordered, are non-returnable and non-refundable unless a manufacturing defect is identified within fourteen (14) days of dispensing.
- This Quotation Estimate does not constitute a medical diagnosis. For conditions requiring surgical intervention or pharmaceutical treatment, the client will be referred to a registered ophthalmologist in India Mumbai at no additional consultation cost.
- The Annual Eye Health Check-up Package is non-transferable and non-refundable. Unused sessions may be rescheduled up to two times with a minimum of 48 hours' prior notice.
- All data collected during the Optometrist consultation is stored in compliance with the Digital Personal Data Protection Act, 2023, and applicable Indian privacy regulations.
- Any disputes arising from this Quotation Estimate shall be subject to the exclusive jurisdiction of the competent courts in Mumbai, Maharashtra, India.
- This Quotation Estimate is issued in duplicate. The client's copy is for reference only and does not constitute a binding contract until formally accepted in writing by both parties.
By signing below, the client acknowledges receipt of this Quotation Estimate for Optometrist services in India Mumbai and agrees to the terms and conditions outlined above. The Quotation Estimate shall become a binding service agreement upon countersignature by the authorized representative of ClearSight Optometry Centre.
Client Signature & DateMr. Rajesh Kumar Sharma
Authorized Signatory – ClearSight Optometry CentreDr. Ananya Deshmukh, Senior Optometrist
For and on behalf of ClearSight Optometry Centre, India Mumbai
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