Quotation Estimate Optometrist in Switzerland Zurich –Free Word Template Download with AI
Bahnhofstrasse 42, 8001 Zürich, Switzerland
Tel: +41 44 555 1234 | Email: [email protected]
VAT No.: CHE-123.456.789
Licensed Optometrist – Switzerland ZurichQuotation Estimate No.: QE-2025-0847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Elena Müller, OD
Professional Optometrist Services – Switzerland Zurich
Prepared For (Client)
Name: Mr. Thomas Keller
Address: Seefeldstrasse 118, 8008 Zürich, Switzerland
Email: [email protected]
Phone: +41 79 123 4567
Insurance Ref.: KVG-2025-88421
Service Location
Facility: Zürich Vision Optometrist Centre
Address: Bahnhofstrasse 42, 8001 Zürich
Region: Kanton Zürich, Switzerland
Service Date: 22 June 2025
Time Slot: 09:00 – 11:30 AM
Itemised Quotation Estimate – Optometrist Services
| Ref. | Service Description | Optometrist Specialist | Duration | Unit Price (CHF) | Total (CHF) |
|---|---|---|---|---|---|
| 01 | Comprehensive Eye Examination including visual acuity testing, refraction, and binocular vision assessment | Dr. Elena Müller, OD | 45 min | 180.00 | 180.00 |
| 02 | Advanced Retinal Screening with dilated fundus examination and digital retinal photography | Dr. Elena Müller, OD | 30 min | 120.00 | 120.00 |
| 03 | Corneal Topography and Pachymetry for contact lens fitting assessment | Dr. Stefan Weber, OD | 20 min | 95.00 | 95.00 |
| 04 | Intraocular Pressure Measurement (Tonometry) with glaucoma risk evaluation | Dr. Stefan Weber, OD | 15 min | 65.00 | 65.00 |
| 05 | Presbyopia Assessment and progressive lens prescription consultation | Dr. Elena Müller, OD | 25 min | 85.00 | 85.00 |
| 06 | Visual Field Analysis (Perimetry) – automated Humphrey 24-2 test | Dr. Stefan Weber, OD | 20 min | 110.00 | 110.00 |
| 07 | Written Optometrist Report with detailed findings, recommendations, and follow-up schedule | Dr. Elena Müller, OD | — | 50.00 | 50.00 |
| 08 | Follow-up consultation (within 4 weeks) for review of findings and adjustment of recommendations | Dr. Elena Müller, OD | 20 min | 75.00 | 75.00 |
| Subtotal | 780.00 CHF |
| VAT (7.7% – Switzerland standard rate) | 60.06 CHF |
| Insurance Reimbursement (KVG basic coverage estimate) | -234.00 CHF |
| Net Amount Due (Client) | 606.06 CHF |
Terms and Conditions of this Quotation Estimate
- This Quotation Estimate is issued by Zürich Vision Optometrist Centre, a registered and licensed Optometrist practice operating in Switzerland Zurich, and is valid for a period of thirty (30) days from the date of issue. After this period, prices and availability of the Optometrist specialists may be subject to change.
- All services listed in this Quotation Estimate are to be performed by a certified Optometrist holding a valid licence issued by the Swiss Federal Commission for Health Professions (EFA/OFAP). The Optometrist will adhere to the professional standards set forth by the Swiss Society of Optometry and Vision Sciences.
- Payment of the net amount due is expected within fourteen (14) days of the service date. Payment may be made via bank transfer to the account of Zürich Vision Optometrist Centre (IBAN: CH93 0900 0000 8888 8888 8) or by credit card. A 1.5% late fee will apply to overdue balances.
- The insurance reimbursement amount indicated in this Quotation Estimate is an estimate based on the client's current KVG (mandatory health insurance) policy terms. The final reimbursement amount is determined solely by the client's insurance provider. The client is responsible for any difference between the estimated and actual reimbursement.
- Cancellation or rescheduling of the Optometrist appointment must be made at least 48 hours in advance. Cancellations made within 48 hours of the scheduled service date will incur a 50% fee of the total Quotation Estimate amount.
- All diagnostic data, retinal images, and written reports generated during the Optometrist consultation are the property of Zürich Vision Optometrist Centre. A copy of the written report will be provided to the client and, upon written consent, to the client's primary care physician or ophthalmologist in Switzerland Zurich.
- This Quotation Estimate does not constitute a medical diagnosis or a guarantee of specific treatment outcomes. The Optometrist will exercise professional judgement during the examination and may recommend additional services not listed herein, which will be quoted separately.
- This Quotation Estimate is governed by the laws of the Swiss Confederation. Any disputes arising from this document shall be subject to the exclusive jurisdiction of the courts in the Canton of Zürich, Switzerland.
- The client acknowledges that by accepting this Quotation Estimate, they consent to the processing of their personal health data in accordance with the Swiss Federal Act on Data Protection (FADP/DSG) and the applicable regulations of Switzerland Zurich.
For Zürich Vision Optometrist Centre
Dr. Elena Müller, OD – Lead Optometrist
Signature: ___________________________
Date: ___________________________
Client Acceptance
Mr. Thomas Keller
Signature: ___________________________
Date: ___________________________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT