Quotation Estimate Optometrist in South Africa Johannesburg –Free Word Template Download with AI
ClearVision Optometry Clinic
142 Rivonia Road, Sandton, Johannesburg, 2196, South Africa
Tel: +27 (0)11 456 7890 | Email: [email protected]
Reg. No: OPT-2019-00482 | HPCSA Reg: 0048219
Client / Recipient Details| Client Name: Mr. James van der Merwe | Account No: CVM-2025-118 |
| Address: 28 Oak Avenue, Fourways, Sandton, Johannesburg, 2191, South Africa | Med Aid Scheme: Discovery Health (Ref: DH-447291) |
| Contact: +27 (0)82 334 5567 | Email: [email protected] |
This Quotation Estimate is issued by ClearVision Optometry Clinic, a registered and accredited Optometrist practice operating in the greater Johannesburg metropolitan area of South Africa. The services outlined below represent a comprehensive ophthalmic and optometric assessment package tailored to the client's specific visual needs. All procedures will be performed by a fully qualified and HPCSA-registered Optometrist in compliance with the Optometrists Act (Act 57 of 1954) as amended, and the Health Professions Council of South Africa (HPCSA) regulations governing the practice of optometry in South Africa.
Itemised Quotation Estimate – Services and Costs| Ref | Description of Optometrist Service | Quantity | Unit Price (ZAR) | Amount (ZAR) |
|---|---|---|---|---|
| 01 | Comprehensive Optometrist Consultation & Visual Acuity Assessment (including manifest and cycloplegic refraction) | 1 | R 850.00 | R 850.00 |
| 02 | Slit-Lamp Biomicroscopy Examination (anterior and posterior segment assessment by the Optometrist) | 1 | R 420.00 | R 420.00 |
| 03 | Dilated Fundus Examination with Digital Retinal Photography (2 images per eye) | 1 | R 680.00 | R 680.00 |
| 04 | Automated Tonometry (Intraocular Pressure Measurement) – screening for glaucoma | 1 | R 250.00 | R 250.00 |
| 05 | Corneal Topography & Pachymetry (OCT – Optical Coherence Tomography) for corneal mapping | 1 | R 950.00 | R 950.00 |
| 06 | Binocular Vision & Ocular Motility Assessment (including cover test, prism adaptation, and stereopsis testing) | 1 | R 380.00 | R 380.00 |
| 07 | Visual Field Perimetry (Humphrey 24-2 Standard Threshold) – bilateral | 1 | R 720.00 | R 720.00 |
| 08 | Optometrist Written Report & Management Plan (including prescription for corrective lenses if indicated) | 1 | R 300.00 | R 300.00 |
| 09 | Follow-up Review Appointment (within 6 weeks) – Optometrist re-assessment and lens adaptation check | 1 | R 450.00 | R 450.00 |
| 10 | Prescription of Single-Vision Lenses (1.67 Index, Anti-Reflective Coating) – pair, including fitting by the Optometrist | 1 | R 3 200.00 | R 3 200.00 |
| 11 | Frame Selection & Adjustment (from in-house Johannesburg collection – client selects from available stock) | 1 | R 1 850.00 | R 1 850.00 |
| Subtotal (Excluding VAT) | R 10 050.00 | |||
| VAT @ 15% (South Africa) | R 1 507.50 | |||
| TOTAL AMOUNT DUE (Including VAT) | R 11 557.50 | |||
All prices are quoted in South African Rand (ZAR) and are inclusive of all applicable taxes as per the South African Revenue Service (SARS) regulations. This Quotation Estimate reflects standard Optometrist fees as gazetted for the Johannesburg, South Africa region for the 2025 financial year.
Terms and Conditions of this Quotation Estimate- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, the Optometrist reserves the right to revise pricing due to changes in medical supply costs, exchange rate fluctuations, or updated HPCSA fee schedules applicable in South Africa Johannesburg.
- All Optometrist services listed in this Quotation Estimate will be performed at the ClearVision Optometry Clinic premises located in Sandton, Johannesburg, South Africa, or at such other location as mutually agreed upon in writing.
- Payment is due within fourteen (14) days of acceptance of this Quotation Estimate. The client may elect to submit the itemised invoice directly to their medical aid scheme (Discovery Health) for pre-authorisation and reimbursement in accordance with their policy benefits. The Optometrist will provide all necessary documentation, including the HPCSA registration number and itemised service codes, to facilitate the claim.
- Any services not explicitly listed in this Quotation Estimate, should they become necessary during the course of the Optometrist examination (e.g., additional diagnostic imaging, referral to an ophthalmologist, or emergency intervention), will be quoted separately and require the client's written consent prior to commencement.
- The Optometrist will adhere to all professional ethical standards as set out by the HPCSA and the Optometrists Association of South Africa (OASA). Client confidentiality is maintained in full compliance with the Protection of Personal Information Act (POPIA), 2013, as applicable in South Africa.
- This Quotation Estimate does not constitute a medical diagnosis. The Optometrist will provide a clinical assessment and management plan. Should the examination reveal a condition requiring ophthalmological surgical intervention, the Optometrist will refer the client to a registered ophthalmologist in Johannesburg, South Africa, and this referral will be documented in the written report.
- Any disputes arising from this Quotation Estimate or the services rendered shall be subject to the jurisdiction of the courts of South Africa, with the Magistrate's Court of Johannesburg having primary jurisdiction.
- The client acknowledges that by signing below, they accept this Quotation Estimate in full and authorise the Optometrist to proceed with the services as described.
For and on behalf of the Optometrist / Practice:
Dr. Thandiwe Mokoena, OptometristHPCSA Reg: 0048219
Date: ______________________
Client / Authorised Signatory:
Mr. James van der MerweID No: 8504125009087
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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