Quotation Estimate Radiologist in Thailand Bangkok –Free Word Template Download with AI
Professional Radiologist Diagnostic Imaging Services — Thailand Bangkok
Official Medical QuotationService Provider
Bangkok Advanced Radiology Center
128 Sukhumvit Road, Khlong Toei
Bangkok 10110, Thailand
Tel: +66 (0) 2 255 8800
Email: [email protected]
License No. TH-RAD-2024-00471
Client / Recipient
Dr. Somchai Prasert
Department of Internal Medicine
Bangkok Memorial Hospital
1331 Sukhumvit Road, Khlong Toei
Bangkok 10110, Thailand
Tel: +66 (0) 2 310 1000
| Quotation Estimate No.: | QTE-BKK-2025-003847 |
| Date of Issue: | 15 June 2025 |
| Valid Until: | 15 July 2025 (30 days from issue date) |
| Assigned Radiologist: | Dr. Ananya Chaiyaporn, MD (Radiology), FRCR — Board-Certified Radiologist, Thailand |
| Payment Currency: | Thai Baht (THB / Þ) |
| Payment Terms: | Net 30 days from date of service delivery |
| Ref | Service Description | Quantity | Unit Price (THB) | Subtotal (THB) |
|---|---|---|---|---|
| 01 | Comprehensive MRI Brain & Spine (3T) — Radiologist interpretation, report, and consultation | 2 | 18,500 | 37,000 |
| 02 | CT Abdomen & Pelvis with IV Contrast — Radiologist diagnostic reading and written report | 3 | 12,800 | 38,400 |
| 03 | Digital Mammography (Bilateral) with 3D Tomosynthesis — Radiologist screening and assessment | 4 | 6,200 | 24,800 |
| 04 | Ultrasound Abdomen & Thyroid — Real-time Radiologist examination and report | 5 | 4,500 | 22,500 |
| 05 | Interventional Radiology — CT-Guided Biopsy (per procedure) including Radiologist supervision | 2 | 32,000 | 64,000 |
| 06 | Plain X-Ray (Chest PA & Lateral) — Radiologist reading and digital report | 10 | 1,800 | 18,000 |
| 07 | Second Opinion Consultation by Senior Radiologist (per case, up to 30 minutes) | 6 | 5,500 | 33,000 |
| 08 | Urgent / After-Hours Radiologist On-Call Service (per activation, 24/7 availability in Thailand Bangkok) | 4 | 8,000 | 32,000 |
The assigned Radiologist, Dr. Ananya Chaiyaporn, holds a Doctor of Medicine degree from Chulalongkorn University, Bangkok, followed by a five-year specialist residency in Diagnostic and Interventional Radiology at Siriraj Hospital, Mahidol University. She is a Fellow of the Royal College of Radiologists (FRCR, United Kingdom) and is registered with the Thai Medical Council (License No. 61-12345). All diagnostic imaging services outlined in this Quotation Estimate will be performed, interpreted, and reported by a board-certified Radiologist in full compliance with the Ministry of Public Health regulations governing medical imaging practice in Thailand Bangkok. The Radiologist maintains a minimum of 40 continuing medical education credits annually and participates in peer-reviewed quality assurance programs administered by the Thai Society of Radiology.
Important Conditions
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Pricing is subject to revision upon expiration without prior notice.
- All services must be performed at the Bangkok Advanced Radiology Center facility located in Khlong Toei, Bangkok, Thailand, unless a mobile Radiologist unit is specifically requested and approved in writing.
- The Radiologist reserves the right to reschedule appointments with a minimum of 24 hours' notice in the event of emergency clinical obligations or equipment maintenance.
- Diagnostic reports will be delivered in both Thai and English within 24 hours of the imaging procedure for standard studies, and within 4 hours for urgent or emergency Radiologist readings.
- Payment is due within thirty (30) days of the final service delivery date. Late payments will incur a surcharge of 1.5% per month as stipulated under Thai commercial law.
- This Quotation Estimate does not constitute a binding contract. A formal service agreement must be executed by both parties prior to the commencement of any Radiologist diagnostic or interventional procedures.
- All patient data and imaging records are handled in strict accordance with the Personal Data Protection Act (PDPA) of Thailand (B.E. 2562 / 2019) and the hospital's data governance policies in Thailand Bangkok.
- Any additional procedures not listed in this Quotation Estimate will be billed separately at the standard Radiologist fee schedule in effect at the time of service.
- This Quotation Estimate is non-transferable and is issued exclusively to the named client institution.
Prepared By (Service Provider)
Dr. Ananya Chaiyaporn, MD (Radiology)
Lead Radiologist, Bangkok Advanced Radiology Center
Date: _______________
Accepted By (Client)
Dr. Somchai Prasert, MD
Head of Internal Medicine, Bangkok Memorial Hospital
Date: _______________
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