Quotation Estimate Optometrist in Venezuela Caracas –Free Word Template Download with AI
Clínica Óptica Mirador del Ávila
Optometrist Services & Vision Care Center
Av. Francisco de Miranda, Torre Empresarial, Piso 12, Chacao, Venezuela Caracas
Tel: +58 (212) 555-0147 | Email: [email protected]
RIF: J-31845672-9 | Health Ministry License No. HME-2019-04471
1. Purpose of This Quotation EstimateThis Quotation Estimate document is issued by Clínica Óptica Mirador del Ávila, a licensed and accredited Optometrist practice located in the heart of Venezuela Caracas, to provide the prospective client with a comprehensive, itemized breakdown of all professional optometric services, diagnostic procedures, corrective lens prescriptions, and associated materials required for a complete vision assessment and correction program. This estimate is prepared in accordance with the regulatory standards established by the Venezuelan Ministry of Health and the National Optometry Board of Venezuela Caracas, ensuring full transparency and compliance with all applicable local and national healthcare regulations.
2. Scope of Optometrist Services IncludedThe following Optometrist services have been evaluated and are included in this Quotation Estimate for delivery at our primary clinic facility in Venezuela Caracas. All procedures will be performed by board-certified optometrists with a minimum of ten (10) years of clinical experience in comprehensive eye care, pediatric optometry, and advanced refractive diagnostics.
| No. | Service / Item Description | Quantity | Unit Price (USD) | Subtotal (USD) | Unit Price (Bs.) |
|---|---|---|---|---|---|
| 01 | Comprehensive Optometrist Eye Examination (visual acuity, refraction, intraocular pressure, fundus examination, and binocular vision assessment) | 1 | $185.00 | $185.00 | 38,420.00 |
| 02 | Advanced Corneal Topography and Pachymetry (digital mapping of corneal curvature and thickness measurement) | 1 | $95.00 | $95.00 | 19,680.00 |
| 03 | Optical Coherence Tomography (OCT) of the retina and optic nerve head | 1 | $120.00 | $120.00 | 24,960.00 |
| 04 | Prescription of custom single-vision lenses (CR-39 material, anti-reflective and anti-scratch coating, UV400 protection) | 1 pair | $210.00 | $210.00 | 43,680.00 |
| 05 | Prescription of progressive (multifocal) lenses (1.67 index, photochromic, anti-reflective coating) | 1 pair | $340.00 | $340.00 | 70,720.00 |
| 06 | Acetate eyeglass frame (Italian-made, hypoallergenic, with adjustable nose pads) | 1 | $175.00 | $175.00 | 36,400.00 |
| 07 | UV400 prescription sunglasses (polarized lenses, titanium frame, case included) | 1 pair | $265.00 | $265.00 | 55,080.00 |
| 08 | Contact lens fitting and trial (soft toric lenses, 6-month supply, care solution kit) | 1 | $195.00 | $195.00 | 40,560.00 |
| 09 | Follow-up Optometrist consultation (30-day post-fitting review, lens adjustment, and prescription verification) | 1 | $75.00 | $75.00 | 15,600.00 |
| 10 | Digital retinal photography (two high-resolution images for medical record and future comparison) | 1 | $55.00 | $55.00 | 11,440.00 |
| Subtotal (USD) | $1,715.00 |
| Subtotal (Bs.) | 356,560.00 |
| Applicable Tax (IVA 16%) | $274.40 / Bs. 57,049.60 |
| GRAND TOTAL (USD) | $1,989.40 |
| GRAND TOTAL (Bs.) | 413,609.60 |
- This Quotation Estimate is a non-binding proposal issued by the Optometrist practice at Clínica Óptica Mirador del Ávila, Venezuela Caracas, and does not constitute a final invoice until formally accepted in writing by the client.
- All Optometrist services listed herein will be performed at our clinic located in Chacao, Venezuela Caracas, during regular business hours (Monday through Friday, 8:00 AM to 5:00 PM; Saturday, 9:00 AM to 1:00 PM).
- The client is required to provide a 50% advance payment upon acceptance of this Quotation Estimate to secure the appointment schedule and reserve the necessary optical materials and lens inventory.
- The remaining 50% balance shall be due and payable upon completion of all services and delivery of the final corrective eyewear or contact lenses.
- Payment may be made in USD (cash or bank transfer) or in Venezuelan Bolívares at the prevailing BCV rate. International wire transfers are accepted with a 3% processing surcharge.
- All corrective lenses and frames carry a manufacturer's warranty of twelve (12) months against defects in materials and workmanship, as per Venezuelan consumer protection law (Ley para la Defensa de los Derechos del Consumidor).
- The Optometrist will provide a written prescription document compliant with Venezuelan health regulations, which the client may use at any other optical provider in Venezuela Caracas or internationally.
- Any additional diagnostic tests or corrective products not explicitly listed in this Quotation Estimate will be quoted separately and require prior written authorization from the client.
- This Quotation Estimate is subject to the general terms of service of Clínica Óptica Mirador del Ávila and the applicable regulations of the Venezuelan Ministry of Health and the National Optometry Board.
- In the event of force majeure, including but not limited to power outages, supply chain disruptions, or government-mandated closures in Venezuela Caracas, the Optometrist practice reserves the right to reschedule services without penalty to either party.
By signing below, the client acknowledges receipt of this Quotation Estimate and authorizes the Optometrist team at Clínica Óptica Mirador del Ávila, Venezuela Caracas, to proceed with the services and materials described herein under the terms and conditions stated above.
Client / Authorized Representative
Name: ______________________________
ID / RIF: ______________________________
Phone: ______________________________
Email: ______________________________
Signature & DateOptometrist / Clinic Representative
Name: Dr. María Elena Rodríguez, O.D.
License No.: OPT-VE-2014-00892
Phone: +58 (212) 555-0147
Email: [email protected]
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