Quotation Estimate Optometrist in Israel Tel Aviv –Free Word Template Download with AI
Shalom Vision Optometry Center
142 Dizengoff Street, Tel Aviv-Yafo, Israel 6310100
Tel: +972-3-621-4580 | Email: [email protected]
VAT No. 51-234-567-8 | License No. OPT-IL-2024-0891
Quotation Estimate Details
Quotation No.: QE-2025-0417-TA
Date Issued: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Prepared By: Dr. Miriam Levi, OD
Service Location: Tel Aviv, Israel
Client Information
Name: Mr. David Ben-Ari
Address: 28 Rothschild Boulevard, Tel Aviv, Israel
Phone: +972-52-734-8821
Email: [email protected]
ID No.: ***-***-***
Dear Mr. Ben-Ari,
Thank you for contacting Shalom Vision Optometry Center for your comprehensive eye care needs. This Quotation Estimate outlines the full scope of Optometrist services we propose to deliver at our Tel Aviv, Israel clinic. Our team of licensed Optometrist professionals is committed to providing world-class vision care tailored to the unique requirements of our patients in the Tel Aviv metropolitan area. Please review the following line items carefully before confirming your acceptance of this Quotation Estimate.
| # | Service Description | Optometrist Specialist | Qty | Unit Price (ILS) | Subtotal (ILS) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dilated Eye Examination (includes visual acuity, refraction, intraocular pressure, and retinal assessment) | Dr. Miriam Levi, OD | 1 | 450.00 | 450.00 |
| 2 | Corneal Topography and Pachymetry (advanced mapping of corneal curvature for contact lens fitting or pre-surgical evaluation) | Dr. Yossi Katz, OD | 1 | 380.00 | 380.00 |
| 3 | Optical Coherence Tomography (OCT) of the macula and optic nerve head | Dr. Miriam Levi, OD | 1 | 320.00 | 320.00 |
| 4 | Binocular Vision and Visual Function Assessment (convergence, divergence, and accommodative facility testing) | Dr. Yossi Katz, OD | 1 | 280.00 | 280.00 |
| 5 | Prescription of Custom Progressive Lenses (bifocal/progressive design, anti-reflective coating, blue-light filter) | Optometrist Team | 2 | 1,250.00 | 2,500.00 |
| 6 | Frame Selection and Fitting (premium acetate frame, Italian manufacture, adjustable nose pads) | Optometrist Team | 1 | 850.00 | 850.00 |
| 7 | Follow-up Vision Check (4 weeks post-dispensing, includes lens adaptation assessment and minor adjustments) | Dr. Miriam Levi, OD | 1 | 150.00 | 150.00 |
| 8 | Annual Eye Health Monitoring Plan (two follow-up examinations per year for the next 12 months, including IOP and retinal screening) | Optometrist Team | 2 | 350.00 | 700.00 |
| Subtotal (excl. VAT) | 5,630.00 ILS |
| VAT (18% - Israel) | 1,013.40 ILS |
| GRAND TOTAL (incl. VAT) | 6,643.40 ILS |
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiration date, pricing for Optometrist services and optical products may be subject to revision based on current market conditions in Tel Aviv, Israel.
- All prices are quoted in Israeli New Shekels (ILS) and include the applicable 18% Value Added Tax (VAT) as mandated by the Israel Tax Authority.
- Payment is due in full within fourteen (14) days of acceptance of this Quotation Estimate. Accepted payment methods include bank transfer (Halanit), credit card (Visa, Mastercard, Amex), and cash at our Tel Aviv clinic.
- The Optometrist services listed herein are performed by licensed Optometrist professionals registered with the Israel Optometrists Association and the Ministry of Health, State of Israel.
- Custom progressive lenses and frames carry a 90-day manufacturer warranty against defects in materials and workmanship. This warranty does not cover damage caused by misuse, accidental breakage, or normal wear.
- Should the client require cancellation of any scheduled Optometrist appointment, a minimum of 48 hours' notice is required to avoid a 20% cancellation fee on the applicable service line item.
- This Quotation Estimate does not constitute a medical diagnosis. Any findings requiring referral to an ophthalmologist or other medical specialist in Tel Aviv, Israel will be communicated separately and are not included in this estimate.
- All personal health data collected during the Optometrist examination is handled in strict compliance with the Israeli Privacy Protection Law, 5741-1981, and the EU General Data Protection Regulation (GDPR) where applicable.
- By signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for Optometrist services at Shalom Vision Optometry Center, Tel Aviv, Israel.
Dr. Miriam Levi, OD
Lead Optometrist
Shalom Vision Optometry Center, Tel Aviv, Israel
Date: 15/06/2025 Client Acceptance:
Mr. David Ben-Ari
Signature: _________________________
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