Quotation Estimate Optometrist in Netherlands Amsterdam –Free Word Template Download with AI
Optometrist & Ophthalmic Services | Keizersgracht 245, 1016 CJ Amsterdam, Netherlands
KvK: 87654321 | BTW: NL861234567B01 | Tel: +31 (0)20 123 4567 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-AMST-00472
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. J. van der Berg, Optometrist
Client Information
Name: [Client Full Name]
Address: [Client Street Address], Amsterdam, Netherlands
Phone: [Client Phone Number]
Email: [Client Email Address]
BSN / Insurance No.: [Client Insurance Number]
Dear Valued Client,
Thank you for contacting Amsterdam Vision Care Centre for your optometry needs. This Quotation Estimate has been prepared specifically for you following your initial consultation with our Optometrist team in our Amsterdam clinic. The services outlined below reflect a comprehensive assessment of your visual health requirements, including diagnostic examinations, corrective lens prescriptions, and follow-up care as recommended by our licensed Optometrist. All pricing is in accordance with the current Dutch healthcare regulations and the supplementary insurance (zorgverzekering) provisions applicable in the Netherlands.
| # | Service / Item Description | Optometrist Notes | Qty | Unit Price (EUR) | Subtotal (EUR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Optometrist Eye Examination (including visual acuity, refraction, binocular vision assessment, and ocular health screening) | Full diagnostic session | 1 | € 85.00 | € 85.00 |
| 2 | Advanced Retinal Imaging (Optical Coherence Tomography - OCT) performed by the Optometrist | Both eyes | 2 | € 45.00 | € 90.00 |
| 3 | Corneal Topography and Pachymetry Assessment | Specialist Optometrist procedure | 1 | € 65.00 | € 65.00 |
| 4 | Prescription for Single-Vision Lenses (including lens design, coating, and anti-reflective treatment) | As prescribed by Optometrist | 1 | € 120.00 | € 120.00 |
| 5 | Frame Selection and Fitting (mid-range frame from Amsterdam Vision Care collection) | Includes nose pad adjustment | 1 | € 95.00 | € 95.00 |
| 6 | Follow-up Consultation with the Optometrist (4-week post-fitting review) | Standard in Amsterdam practice | 1 | € 35.00 | € 35.00 |
| 7 | Annual Eye Health Monitoring Plan (includes 2 check-ups per year with the Optometrist) | Preventive care programme | 1 | € 110.00 | € 110.00 |
| 8 | Blue Light Filtering Coating Add-on (for digital screen users) | Recommended by Optometrist | 1 | € 40.00 | € 40.00 |
| Subtotal (excl. VAT): | € 640.00 | ||||
| VAT (21% - Netherlands): | € 134.40 | ||||
| Total Amount Due (incl. VAT): | € 774.40 | ||||
* Note: A portion of the above services may be reimbursed through your Dutch supplementary health insurance (aanvullende zorgverzekering). Please verify your coverage with your insurer (e.g., Zilveren Kruis, VGZ, Menzis, CZ, or OHRA) prior to payment. Our Optometrist team in Amsterdam can provide the necessary documentation for your insurance claim.
Terms and Conditions of this Quotation Estimate
- This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, prices may be subject to revision based on supplier costs and updated Optometrist service fees in the Netherlands Amsterdam region.
- All services will be performed by a licensed Optometrist registered with the Dutch Optometrist Association (Nederlandse Vereniging van Optometristen - NVO).
- Payment is due within 14 days of acceptance of this Quotation Estimate. We accept bank transfer (iDEAL, SEPA), credit card, and direct debit arrangements common in the Netherlands.
- Should the client wish to cancel any scheduled appointment, a 48-hour notice must be provided to our Amsterdam clinic. Late cancellations may incur a fee of € 25.00.
- The Optometrist reserves the right to modify the treatment plan if additional diagnostic findings are discovered during the examination. Any additional costs will be communicated and approved by the client before proceeding.
- All patient data is handled in strict compliance with the Dutch GDPR (AVG) regulations and the Dutch Healthcare Act (Wgbo). Your visual health records will be stored securely at our Amsterdam facility.
- This Quotation Estimate does not constitute a binding contract until signed and returned by both parties. Amsterdam Vision Care Centre will confirm scheduling within 3 business days of receiving the signed document.
- Warranty: All corrective lenses and frames carry a 12-month warranty against manufacturing defects, as is standard practice for Optometrist-provided eyewear in the Netherlands.
For Amsterdam Vision Care Centre
Dr. J. van der Berg, OptometristAuthorized Signatory
Client Acceptance
[Client Full Name]Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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