Quotation Estimate Optometrist in Mexico Mexico City –Free Word Template Download with AI
Av. Paseo de la Reforma 245, Piso 8, Col. Cuauhtémoc, 06600 Mexico Mexico City, Mexico
Tel: +52 (55) 5512-3456 | Email: [email protected] | RFC: VCV180520AB1
Licensed Optometrist Practice
Quotation EstimateQuotation Details
Quotation No.: QE-2025-0847
Date Issued: June 15, 2025
Valid Until: July 15, 2025
Prepared By: Dr. Alejandro Ramírez, O.D.
Location: Mexico Mexico City
Client Information
Name: [Client Full Name]
Address: [Client Address], Mexico Mexico City
Phone: [Client Phone Number]
Email: [Client Email]
Insurance Provider: [Provider Name / N/A]
Dear Valued Client,
Thank you for considering the professional optometric services offered by our clinic in Mexico Mexico City. This Quotation Estimate has been carefully prepared to provide you with a transparent and comprehensive breakdown of all costs associated with your comprehensive optometry consultation and related services. As a licensed Optometrist practice registered with the Mexican Ministry of Health (Secretaría de Salud), we are committed to delivering the highest standard of eye care in the Mexico Mexico City metropolitan area.
Itemized Services and Costs| No. | Service Description | Optometrist Professional | Qty | Unit Price (MXN) | Subtotal (MXN) |
|---|---|---|---|---|---|
| 1 | Comprehensive Eye Examination (Visual Acuity, Refraction, Intraocular Pressure, Fundus Examination) | Dr. Alejandro Ramírez, O.D. | 1 | $1,850.00 | $1,850.00 |
| 2 | Corneal Topography and Keratometry Analysis | Dr. Alejandro Ramírez, O.D. | 1 | $1,200.00 | $1,200.00 |
| 3 | Dilated Pupil Examination with Mydriatic Drops | Dr. Alejandro Ramírez, O.D. | 1 | $650.00 | $650.00 |
| 4 | Optical Dispensing – Bifocal Lenses (CR-39, Anti-Reflective Coating) | Optical Lab – Mexico Mexico City | 1 pair | $4,500.00 | $4,500.00 |
| 5 | Frame Selection and Fitting (Designer Frame – Client's Choice) | Optical Lab – Mexico Mexico City | 1 | $3,200.00 | $3,200.00 |
| 6 | Follow-Up Consultation (30 days post-dispensing) | Dr. Alejandro Ramírez, O.D. | 1 | $800.00 | $800.00 |
| 7 | Visual Field Test (Perimetry) – Optional Add-On | Dr. Alejandro Ramírez, O.D. | 1 | $950.00 | $950.00 |
| 8 | Optical Dispensing – Reading Glasses (Single Vision, Blue-Light Filter) | Optical Lab – Mexico Mexico City | 1 pair | $2,800.00 | $2,800.00 |
| Subtotal (MXN): | $15,950.00 | ||||
| IVA (16% Tax – Mexico Mexico City): | $2,552.00 | ||||
| TOTAL ESTIMATED COST (MXN): | $18,502.00 | ||||
This Quotation Estimate covers the full range of optometric services to be performed by our licensed Optometrist, Dr. Alejandro Ramírez, at our clinic located in the heart of Mexico Mexico City. The comprehensive eye examination includes a thorough assessment of your visual acuity, refractive error, ocular health, and overall eye function. All diagnostic procedures will be conducted using state-of-the-art equipment calibrated to international standards.
The optical dispensing services are handled by our in-house laboratory in Mexico Mexico City, ensuring precise lens grinding, proper frame fitting, and quality control before delivery. Your Optometrist will personally supervise the fitting process to guarantee optimal comfort and visual correction. Please note that the frame selection listed in this estimate is based on the current catalog; should you choose a different frame, the cost may be adjusted accordingly, and a revised Quotation Estimate will be issued.
All services are performed in compliance with the regulations established by the Mexican Federal Health Law (Ley General de Salud) and the professional standards set forth by the Colegio de Ópticos de Mexico Mexico City. Our practice maintains full liability insurance coverage for all procedures performed.
Terms and Conditions- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision due to changes in material costs or exchange rates applicable in Mexico Mexico City.
- Payment Terms: A 50% deposit is required at the time of acceptance to schedule your appointment. The remaining 50% is due upon completion of all services and delivery of your eyewear. Payment may be made in Mexican Pesos (MXN) via bank transfer, credit/debit card, or cash at our Mexico Mexico City office.
- Cancellation Policy: Should the client cancel the appointment with less than 48 hours' notice, the deposit will be forfeited. Rescheduling is permitted up to two (2) times without additional charge.
- Warranty: All dispensed lenses carry a 12-month warranty against manufacturing defects. Frames carry a 6-month warranty. This warranty is valid only for services performed at our Mexico Mexico City location.
- Insurance: If the client has private health insurance (Seguro de Gastos Médicos Mayores), a pre-authorization form will be provided. The client is responsible for any co-payments or deductibles not covered by their policy. This Quotation Estimate reflects the full out-of-pocket cost in the absence of insurance coverage.
- Confidentiality: All patient records and optometric data are handled in strict accordance with Mexico's Federal Law on the Protection of Personal Data Held by Private Parties (LFPDPPP). Your Optometrist and our staff are bound by professional confidentiality obligations.
- Acceptance: By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined herein. This document does not constitute a binding contract until the deposit is received and the appointment is confirmed in writing by our office in Mexico Mexico City.
Dr. Alejandro Ramírez, O.D.
License No. OM-4521-MX
Fecha: _______________ Accepted By (Client)
Name: _________________________
Signature: _________________________
Fecha: _______________ ⬇️ Download as DOCX Edit online as DOCX
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