Quotation Estimate Optometrist in Russia Saint Petersburg –Free Word Template Download with AI
Professional Optometrist Services — Russia Saint Petersburg
Document Reference: QTE-SPB-2025-0472
| Quotation Estimate No.: | QTE-SPB-2025-0472 | Date of Issue: | 15 June 2025 |
| Valid Until: | 15 July 2025 (30 calendar days) | Currency: | Russian Ruble (RUB) |
| Service Location: | Nevsky Prospekt 88, Saint Petersburg, Russia 191025 | ||
| Prepared By: | Dr. Elena V. Sokolova, Lead Optometrist | Department: | Comprehensive Eye Care & Vision Sciences |
| Client Name / Organization: | ____________________________ |
| Address: | ____________________________, Saint Petersburg, Russia |
| Contact Person: | ____________________________ |
| Phone / Email: | ____________________________ |
This Quotation Estimate is issued by our certified Optometrist practice located in Russia Saint Petersburg to provide a comprehensive breakdown of professional eye examination, diagnostic, and corrective services. All services described herein are delivered in accordance with the Federal Law of the Russian Federation on Healthcare (No. 323-FZ) and the professional standards established by the Russian Optometric Association. The Optometrist team at our Saint Petersburg clinic is fully licensed to perform all procedures listed below within the jurisdiction of Russia Saint Petersburg.
| No. | Service Description | Quantity | Unit Price (RUB) | Total (RUB) | Duration |
|---|---|---|---|---|---|
| 1 | Comprehensive Optometrist Eye Examination (visual acuity, refraction, binocular vision assessment, ocular motility testing) | 1 session | 4,500 | 4,500 | 45 min |
| 2 | Autorefraction and Keratometry (computerized measurement of refractive error and corneal curvature) | 1 session | 2,800 | 2,800 | 15 min |
| 3 | Slit-Lamp Biomicroscopy Examination (anterior segment evaluation by the Optometrist) | 1 session | 3,200 | 3,200 | 20 min |
| 4 | Dilated Fundus Examination with Direct and Indirect Ophthalmoscopy | 1 session | 3,500 | 3,500 | 25 min |
| 5 | Non-Mydriatic Fundus Photography (digital imaging of the retina, optic disc, and macula) | 2 images | 1,800 | 3,600 | 10 min |
| 6 | Optical Coherence Tomography (OCT) of the Macula and Optic Nerve Head | 1 session | 5,500 | 5,500 | 20 min |
| 7 | Visual Field Perimetry (automated Humphrey 24-2 or 30-2 field test) | 1 session | 4,200 | 4,200 | 30 min |
| 8 | Intraocular Pressure Measurement (Goldmann applanation tonometry) | 1 session | 1,500 | 1,500 | 10 min |
| 9 | Corneal Topography (Pentacam or equivalent rotating Scheimpflug imaging) | 1 session | 4,800 | 4,800 | 15 min |
| 10 | Optometrist Consultation and Prescription of Corrective Lenses (spectacles or contact lenses) with written report | 1 session | 2,000 | 2,000 | 20 min |
| 11 | Follow-up Optometrist Review (post-examination assessment, lens fitting verification, and aftercare guidance) | 1 session | 2,500 | 2,500 | 20 min |
| SUBTOTAL | 38,100 | ||||
| VAT (20% — Russia Saint Petersburg tax jurisdiction) | 7,620 | ||||
| GRAND TOTAL | 45,720 | ||||
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Optometrist practice reserves the right to revise pricing due to changes in equipment costs, regulatory fees, or market conditions within Russia Saint Petersburg.
- Payment Terms: Full payment is due within fourteen (14) business days of acceptance of this Quotation Estimate. Payment may be made via bank transfer to the clinic account in Saint Petersburg, Russia, or by cash at the front desk. A 5% late-payment surcharge applies to overdue balances.
- Scheduling: Upon acceptance, the Optometrist team will coordinate appointment scheduling within five (5) business days. All sessions are conducted at our facility on Nevsky Prospekt, Saint Petersburg, Russia, between 09:00 and 19:00 on weekdays and 09:00 to 15:00 on Saturdays.
- Medical Records: All diagnostic data, imaging files, and the written Optometrist report will be stored in the patient's medical record in compliance with Russian Federal Law No. 152-FZ on Personal Data. The client may request a digital copy of all findings at no additional charge.
- Cancellations: Appointments may be rescheduled up to 24 hours in advance without penalty. Cancellations within 24 hours or no-shows will incur a 50% fee of the scheduled session cost.
- Warranty on Prescriptions: The Optometrist guarantees the accuracy of all refractive prescriptions issued under this Quotation Estimate. If a discrepancy is identified within 30 days of the initial fitting, a complimentary re-examination will be performed.
- Regulatory Compliance: All services are performed in strict adherence to the licensing requirements of the Ministry of Health of the Russian Federation. The clinic holds a valid medical activity license (No. ЛО-78-01-00XXXX) registered in Saint Petersburg, Russia.
- Confidentiality: The Optometrist and all supporting staff are bound by professional medical confidentiality. No patient data will be disclosed to third parties without written consent, except as required by Russian law.
By signing below, the client acknowledges receipt of this Quotation Estimate for Optometrist services in Russia Saint Petersburg and agrees to the terms, conditions, and pricing outlined in this document. The Optometrist practice will commence scheduling upon receipt of the signed authorization and confirmed payment.
For the Optometrist Practice:
Dr. Elena V. Sokolova
Lead Optometrist, M.D., Ph.D.
Clinic Director
For the Client:
Name: ________________________
Title: ________________________
Organization: ________________________
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