Quotation Estimate Optometrist in Japan Osaka –Free Word Template Download with AI

Quotation Estimate

Quotation Details

Quotation Estimate No.: QTE-OSK-2025-0312

Date of Issue: June 15, 2025

Valid Until: July 15, 2025

Prepared By: Dr. Kenji Tanaka, Lead Optometrist

Client Information

Client Name: Mr. Hiroshi Yamamoto

Address: 5-2-1 Tennoji, Sumiyoshi-ku, Osaka, Japan Osaka

Phone: +81-90-5543-2211

Email: [email protected]

Dear Mr. Yamamoto,

Thank you for contacting Osaka Vision Care Optometry Clinic regarding your comprehensive eye care needs. This Quotation Estimate has been carefully prepared by our senior Optometrist team to outline the full scope of services, associated costs, and professional recommendations for your complete ophthalmic evaluation and corrective lens prescription. As a licensed and accredited practice operating in the heart of Japan Osaka, we are committed to delivering the highest standard of optometric care in accordance with the Japanese Optometric Association guidelines and the Ministry of Health, Labour and Welfare regulations.

The following Quotation Estimate details all services that our Optometrist will perform during your scheduled comprehensive examination at our Japan Osaka clinic facility. Please review each line item carefully and do not hesitate to contact our front desk if any clarification is required before you confirm your acceptance of this estimate.

Itemized Services and Costs

No.	Service Description	Optometrist / Specialist	Duration	Unit Price (JPY)	Total (JPY)
1	Comprehensive Visual Acuity Assessment (Bilateral, Distance & Near)	Dr. Kenji Tanaka, Optometrist	20 min	¥5,500	¥5,500
2	Autorefractometry and Manual Refraction (Subjective & Objective)	Dr. Kenji Tanaka, Optometrist	25 min	¥7,800	¥7,800
3	Binocular Vision and Ocular Motility Examination	Dr. Kenji Tanaka, Optometrist	15 min	¥4,200	¥4,200
4	Slit-Lamp Biomicroscopy and Anterior Segment Evaluation	Dr. Yuki Sato, Optometrist	15 min	¥6,000	¥6,000
5	Dilated Fundus Examination with Digital Retinal Imaging	Dr. Yuki Sato, Optometrist	20 min	¥8,500	¥8,500
6	Corneal Topography and Pachymetry Measurement	Dr. Yuki Sato, Optometrist	15 min	¥6,800	¥6,800
7	Intraocular Pressure Measurement (Non-Contact Tonometry)	Dr. Kenji Tanaka, Optometrist	10 min	¥3,500	¥3,500
8	Visual Field Testing (Humphrey 30-2 Automated Perimetry)	Dr. Yuki Sato, Optometrist	25 min	¥9,200	¥9,200
9	Optical Dispensing Consultation and Frame Fitting (Japan Osaka In-Store)	Ms. Aiko Fujimoto, Dispensing Optician	30 min	¥4,500	¥4,500
10	Prescription Lenses (1.67 Index, Anti-Reflective, Blue-Light Filter)	Osaka Vision Care Lens Lab	5 days	¥38,000	¥38,000
11	Follow-Up Review and Lens Adaptation Check (Japan Osaka Clinic)	Dr. Kenji Tanaka, Optometrist	15 min	¥3,000	¥3,000
Subtotal (Before Tax)					¥97,000
Consumption Tax (10%)					¥9,700
Grand Total (Quotation Estimate)					¥106,700

Notes and Professional Recommendations

Our Optometrist, Dr. Kenji Tanaka, has noted preliminary indications of mild myopic progression and early presbyopic onset based on your initial screening. The comprehensive examination outlined in this Quotation Estimate is designed to confirm these findings and establish a precise corrective prescription. All diagnostic equipment at our Japan Osaka facility is calibrated and certified in compliance with the Japanese Medical Appliance Act. The lens fabrication will be completed in-house at our Osaka laboratory to ensure optimal optical quality and a five-business-day turnaround.

Terms and Conditions of This Quotation Estimate

1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing for the Optometrist services and lens components may be subject to revision based on supplier cost adjustments in the Japan Osaka market.

2. Payment Terms: A deposit of 50% (¥53,350) is required at the time of booking to secure your appointment slot with the Optometrist. The remaining balance is due upon collection of your finished lenses at our Japan Osaka clinic. We accept cash, credit cards (Visa, Mastercard, JCB), and bank transfer.

3. Cancellation Policy: Cancellations made more than 72 hours before your scheduled appointment will receive a full deposit refund. Cancellations within 72 hours will forfeit 50% of the deposit. No-shows will forfeit the entire deposit.

4. Insurance and Reimbursement: This Quotation Estimate reflects self-pay (shinryō) pricing. If your health insurance covers any portion of the diagnostic services, the applicable co-payment amount will be adjusted at the point of service. Please bring your Japan Osaka health insurance card (kenpo kōken) to your appointment.

5. Warranty: All prescription lenses carry a 12-month manufacturing defect warranty. The Optometrist will re-examine your vision free of charge within 30 days of lens delivery if you experience persistent visual discomfort.

6. Privacy: All patient records and examination data are handled in strict accordance with the Japanese Act on the Protection of Personal Information (APPI). Your information will not be shared with third parties without written consent.

Acceptance and Authorization

By signing below, the client acknowledges that this Quotation Estimate has been reviewed and understood. The client authorizes the Optometrist and associated clinical staff at Osaka Vision Care Optometry Clinic, Japan Osaka, to perform the services and procedures itemized above.

Client Signature
Name: Hiroshi Yamamoto
Date: _______________ Optometrist / Clinic Representative
Name: Dr. Kenji Tanaka
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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