Quotation Estimate Optometrist in Thailand Bangkok –Free Word Template Download with AI
Professional Optometrist Services — Thailand Bangkok
Ref: QTE-BKK-2025-04782 | Date: 15 June 2025
VALID FOR 30 DAYSThis Quotation Estimate has been prepared by Bangkok Vision & Optometry Centre to provide Mr. James R. Whitfield with a comprehensive and transparent breakdown of all anticipated costs associated with a full Optometrist consultation, diagnostic eye examination, and corrective lens prescription to be performed in Thailand Bangkok. This document serves as a formal pricing reference and does not constitute a binding contract until both parties have signed and accepted the terms outlined herein. All services described below are to be delivered by a licensed Optometrist registered with the Thai Ministry of Public Health and the Optometric Association of Thailand.
The following Optometrist services are included in this Quotation Estimate for delivery at our Thailand Bangkok facility. Each procedure is performed by a board-certified Optometrist with a minimum of ten years of clinical experience in comprehensive eye care:
| # | Service Description | Optometrist Procedure | Duration | Unit Price (THB) | Amount (THB) |
|---|---|---|---|---|---|
| 1 | Comprehensive Optometrist Consultation & Medical History Review | Full anamnesis, lifestyle assessment, medication review | 20 min | 1,500 | 1,500 |
| 2 | Autorefractometry & Subjective Refraction | Computerised refraction followed by manual fine-tuning by Optometrist | 25 min | 2,000 | 2,000 |
| 3 | Slit-Lamp Biomicroscopy & Anterior Segment Examination | Detailed inspection of cornea, iris, lens, and anterior chamber | 15 min | 1,800 | 1,800 |
| 4 | Dilated Fundus Examination & Retinal Imaging | Mydriatic drops, fundus photography, and OCT scan of macula | 30 min | 3,500 | 3,500 |
| 5 | Visual Field Testing (Perimetry) | Automated Humphrey 24-2 visual field assessment | 20 min | 2,200 | 2,200 |
| 6 | Binocular Vision & Ocular Motility Assessment | Cover testing, prism adaptation, convergence evaluation | 15 min | 1,200 | 1,200 |
| 7 | Intraocular Pressure Measurement (Non-Contact Tonometry) | Air-puff tonometry with repeat readings | 10 min | 800 | 800 |
| 8 | Corneal Topography & Pachymetry | Placido disc topography and ultrasound corneal thickness | 15 min | 2,500 | 2,500 |
| 9 | Optometrist Prescription & Lens Recommendation | Written prescription, lens type advisory, frame consultation | 15 min | 1,000 | 1,000 |
| 10 | Follow-Up Review (within 14 days) | Post-dilation recovery check and prescription verification | 15 min | 800 | 800 |
| Description | Amount (THB) |
|---|---|
| Subtotal — All Optometrist Services | 20,300 |
| VAT (7% — Thailand Revenue Department) | 1,421 |
| Grand Total (Quotation Estimate) | 21,721 |
| Approximate USD Equivalent (at 36 THB/USD) | $603.36 |
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on current Thailand Bangkok healthcare market rates and exchange rate fluctuations.
- All Optometrist services listed herein are to be performed at the Bangkok Vision & Optometry Centre, 88 Sukhumvit Road, Bangkok, Thailand. The patient is responsible for arranging their own travel, accommodation, and transportation to the Thailand Bangkok facility.
- Payment is due in full prior to the commencement of the Optometrist examination. Accepted payment methods include bank transfer (Thai Baht or USD), major credit cards (Visa, Mastercard, Amex), and cash. A 5% surcharge applies to credit card transactions.
- The attending Optometrist reserves the right to modify the scope of examination if clinical findings during the session warrant additional or alternative diagnostic procedures. Any such modifications will be communicated to the patient in writing before execution, and a revised Quotation Estimate will be provided for approval.
- All medical records, digital images, and the written Optometrist prescription generated during this engagement are the property of the patient. A digital copy will be provided via secure email within 48 hours of the examination. Hard copies may be requested at no additional charge.
- This Quotation Estimate does not include the cost of corrective eyewear (spectacle lenses, frames, or contact lenses). A separate itemised estimate for optical products will be provided upon the patient's request following the Optometrist consultation.
- Cancellation or rescheduling must be communicated at least 48 hours in advance. Cancellations within 48 hours will incur a 25% administrative fee of the total Quotation Estimate value.
- By signing below, the patient acknowledges that this Quotation Estimate has been reviewed, all terms are understood, and the Optometrist services described are accepted at the stated Thailand Bangkok facility rates.
Dr. Ananya Chaiyaporn, O.D.
Bangkok Vision & Optometry Centre
Date: _______________ Accepted By (Patient)
Mr. James R. Whitfield
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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