Quotation Estimate Optometrist in Saudi Arabia Jeddah –Free Word Template Download with AI
Professional Optometrist Services — Saudi Arabia Jeddah
Document No: QE-2025-JED-0472
Date of Issue: 15 June 2025 | Valid Until: 15 July 2025
Prepared By:Al-Nour Vision Care Center
Optometrist Services Division
King Fahd Road, Al Shati District
Jeddah 23412, Saudi Arabia
Tel: +966 12 655 4321
Email: [email protected] Prepared For:
Client Name: ______________________
Organization: ______________________
Address: Jeddah, Saudi Arabia
Contact: ______________________
CR / VAT No: ______________________ 1. Purpose of This Quotation Estimate
This Quotation Estimate is issued by Al-Nour Vision Care Center, a licensed and accredited Optometrist practice operating in Saudi Arabia Jeddah, to provide the client with a comprehensive and transparent breakdown of costs associated with professional optometric services. This document serves as a formal estimate for the scope of work, equipment usage, and professional fees required to deliver complete eye examination and corrective lens services in accordance with the standards set by the Saudi Food and Drug Authority (SFDA) and the Ministry of Health of the Kingdom of Saudi Arabia. All pricing in this Quotation Estimate reflects current market rates in the Jeddah metropolitan area and is subject to the terms outlined herein.
2. Scope of Optometrist ServicesThe following Optometrist services are included in this Quotation Estimate for delivery at our clinic facility located in the Al Shati District of Saudi Arabia Jeddah. Each service is performed by a board-certified Optometrist holding a valid license issued by the Saudi Commission for Health Specialties (SCFHS) and registered with the Saudi Optometric Association.
| Ref | Service Description | Optometrist Professional | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dilated Eye Examination including visual acuity testing, refraction, and retinal assessment | Dr. Optometrist (Senior) | 1 | 450.00 | 450.00 |
| 02 | Corneal Topography and Pachymetry Measurement for contact lens fitting evaluation | Dr. Optometrist (Senior) | 1 | 380.00 | 380.00 |
| 03 | Intraocular Pressure (IOP) Measurement and Glaucoma Risk Screening | Dr. Optometrist (Mid-Level) | 1 | 220.00 | 220.00 |
| 04 | Binocular Vision Assessment and Ocular Motility Testing | Dr. Optometrist (Mid-Level) | 1 | 275.00 | 275.00 |
| 05 | Prescription of Single-Vision or Progressive Lenses with frame fitting and adjustment | Dr. Optometrist (Senior) | 1 | 350.00 | 350.00 |
| 06 | Soft Contact Lens Fitting, Trial, and Follow-up Review (includes 2 weeks of adjustment) | Dr. Optometrist (Senior) | 1 | 520.00 | 520.00 |
| 07 | Low Vision Assessment and Magnification Device Recommendation | Dr. Optometrist (Specialist) | 1 | 600.00 | 600.00 |
| 08 | Annual Follow-up Examination and Prescription Update | Dr. Optometrist (Mid-Level) | 2 | 300.00 | 600.00 |
| 09 | Optical Dispensing: Premium Anti-Reflective Coated Lenses (per pair) | Optical Lab / Optometrist | 1 | 1,200.00 | 1,200.00 |
| 10 | Emergency Same-Day Optometrist Consultation (if required within validity period) | Dr. Optometrist (On-Call) | 1 | 350.00 | 350.00 |
| Subtotal | 5,345.00 | ||||
| VAT (15% — Kingdom of Saudi Arabia) | 801.75 | ||||
| Grand Total (SAR) | 6,146.75 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, all prices are subject to revision based on current market conditions in Saudi Arabia Jeddah.
- All Optometrist services listed herein shall be performed in compliance with the regulations of the Saudi Ministry of Health and the Saudi Food and Drug Authority (SFDA). The Optometrist providing care holds a valid professional license and malpractice insurance.
- Payment terms: 50% advance payment upon acceptance of this Quotation Estimate, and the remaining 50% due upon completion of all scheduled services. Payment may be made via bank transfer, credit card, or approved electronic payment methods accepted in Saudi Arabia.
- The client acknowledges that this Quotation Estimate covers the professional Optometrist fees, diagnostic equipment usage, and optical dispensing as itemized. Any additional services not listed (e.g., surgical referral, specialized imaging such as OCT) will be quoted separately at the time of need.
- All services will be delivered at our clinic premises in Jeddah, Saudi Arabia, or at the client's designated location within the Jeddah metropolitan area if a house-call Optometrist service is requested (additional travel fee of SAR 150 applies).
- Confidentiality: All patient records, prescription data, and examination results obtained during the Optometrist consultation are protected under Saudi data privacy laws and will not be disclosed to third parties without written consent.
- This Quotation Estimate does not constitute a binding contract until both parties have signed and stamped the acceptance section below. Upon acceptance, a formal Service Agreement will be executed.
- Any cancellation of scheduled Optometrist appointments must be communicated at least 48 hours in advance. Late cancellations may incur a 20% fee of the scheduled session cost.
By signing below, both parties confirm that this Quotation Estimate for Optometrist services in Saudi Arabia Jeddah has been reviewed, understood, and accepted in its entirety. This document serves as the financial basis for the delivery of the professional optometric care described above.
For Al-Nour Vision Care CenterAuthorized Signatory / Lead Optometrist
Name: ______________________
Date: ______________________ For the Client
Authorized Representative
Name: ______________________
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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