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

Optometrist Professional Services — Japan Tokyo

Document No: QE-TOK-2025-0487

Provider (Optometrist Practice)

Tokyo Vision Care Optometry Center

Address: 3-14-27 Shibuya, Shibuya-ku, Tokyo 150-0042, Japan

Phone: +81-3-5411-7820

Email: [email protected]

License No: JP-OPM-2019-4472 (Japan Optometrist Registry)

Client / Recipient

Mr. Kenji Tanaka

Address: 12-5-8 Minato, Minato-ku, Tokyo 107-0061, Japan

Phone: +81-90-5523-8814

Email: [email protected]

Company: Tanaka Industrial Co., Ltd.

Quotation Estimate Date: June 12, 2025

Valid Until: July 12, 2025 (30 days from issue date)

Service Location: Tokyo Vision Care Optometry Center, Shibuya, Japan Tokyo

Prepared By: Dr. Yuki Morimoto, Registered Optometrist (日本視能訓練士)

Currency: Japanese Yen (JPY / ¥)

This Quotation Estimate outlines the comprehensive optometry services to be provided by our licensed Optometrist team at our Japan Tokyo facility. All procedures will be conducted in accordance with the standards set by the Japan Optometric Association and the Ministry of Health, Labour and Welfare guidelines applicable to vision care professionals operating in the Tokyo metropolitan area.

No. Service Description Optometrist Specialist Qty Unit Price (JPY) Subtotal (JPY)
1 Comprehensive Eye Examination (autorefractometry, keratometry, intraocular pressure measurement, and visual acuity testing) Dr. Yuki Morimoto 1 ¥12,000 ¥12,000
2 Dilated Fundus Examination with Digital Retinal Imaging (OCT scan included) Dr. Yuki Morimoto 1 ¥8,500 ¥8,500
3 Binocular Vision Assessment & Stereopsis Testing Ms. Aiko Sato, Optometrist 1 ¥6,000 ¥6,000
4 Custom Prescription Lens Fitting (progressive multifocal lenses, anti-reflective coating, blue-light filter) Ms. Aiko Sato, Optometrist 1 pair ¥45,000 ¥45,000
5 Frame Selection Consultation & Fitting (premium acetate frame, Japan Tokyo exclusive collection) Optometrist Team 1 ¥28,000 ¥28,000
6 Follow-up Vision Check (4 weeks post-fitting, adjustment and re-measurement) Dr. Yuki Morimoto 1 ¥5,000 ¥5,000
7 Annual Eye Health Screening Package (for corporate wellness program, up to 10 employees) Optometrist Team 10 ¥7,500 ¥75,000
8 Digital Prescription Record & Japan Tokyo Health Insurance Filing (Shakai Hoken compatible) Administrative Staff 1 ¥3,000 ¥3,000
SUBTOTAL ¥182,500
Consumption Tax (10%) ¥18,250
TOTAL AMOUNT DUE ¥200,750
  1. 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 in Japan Tokyo may be subject to revision based on material costs, equipment depreciation, or regulatory changes.
  2. All Optometrist procedures listed herein will be performed at our registered facility in Shibuya, Japan Tokyo, or at the client's designated corporate location within the 23-ward Tokyo metropolitan area, as mutually agreed upon in writing prior to scheduling.
  3. Payment is due within fourteen (14) days of the date of this Quotation Estimate acceptance. Payment may be made via bank transfer to the account specified on the accompanying invoice, or by credit card (Visa, Mastercard, JCB, Amex) at our Japan Tokyo reception desk.
  4. The corporate wellness screening package (Item 7) requires a minimum of five (5) participants to be scheduled. If fewer than five employees attend, the per-unit price will be adjusted to ¥10,000 per person, and this Quotation Estimate total will be recalculated accordingly.
  5. All diagnostic findings, prescription data, and retinal images obtained during the Optometrist examination will be stored in compliance with Japan's Act on the Protection of Personal Information (APPI). Records will be retained for a minimum of ten (10) years as required by the Japan Optometric Association.
  6. Cancellation or rescheduling of any Optometrist appointment must be made at least forty-eight (48) hours in advance. Late cancellations within 48 hours will incur a 50% service fee of the scheduled procedure cost.
  7. This Quotation Estimate does not constitute a medical diagnosis. Should the Optometrist identify a condition requiring referral to an ophthalmologist (eye surgeon), the client will be advised accordingly, and any subsequent specialist fees are not included in this estimate.
  8. All lens and frame products are covered by a twelve-month warranty against manufacturing defects. The warranty is valid only for services rendered at our Japan Tokyo location and is non-transferable.
  9. This Quotation Estimate is prepared exclusively for the named client and may not be transferred, assigned, or used by any third party without prior written consent from Tokyo Vision Care Optometry Center.
  10. Governance: This Quotation Estimate and any resulting service agreement shall be governed by the laws of Japan, with jurisdiction vested in the Tokyo District Court.

By signing below, the client acknowledges and accepts all terms, conditions, and pricing outlined in this Quotation Estimate for Optometrist services to be delivered in Japan Tokyo. The provider confirms that all listed services will be performed by licensed, registered Optometrist professionals in full compliance with Japanese healthcare regulations.

For: Tokyo Vision Care Optometry Center
Dr. Yuki Morimoto, Lead Optometrist
Date: ______________________
For: Tanaka Industrial Co., Ltd.
Mr. Kenji Tanaka, Authorized Representative
Date: ______________________

Tokyo Vision Care Optometry Center — 3-14-27 Shibuya, Shibuya-ku, Tokyo 150-0042, Japan

Quotation Estimate No. QE-TOK-2025-0487 | Generated: June 12, 2025 | Page 1 of 1

This document is a formal Quotation Estimate for Optometrist services in Japan Tokyo and is not a binding contract until countersigned by both parties.

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