Quotation Estimate Surgeon in Brazil Brasília –Free Word Template Download with AI
Professional Surgeon Services — Medical & Surgical Procedures
Brazil — Brasília, DFService Provider
Dr. Ricardo Almeida, MD, FACS
Board-Certified General & Vascular Surgeon
Cremedico-DF Registration: 18.452
Clínica Cirúrgica do Planalto
SHLS Quadra 05, Bloco B, Sala 412
Brasília — DF — CEP 70310-500
Tel: +55 (61) 3344-7890
Email: [email protected]
Client / Recipient
Empresa de Saúde Corporativa Ltda.
CNPJ: 12.345.678/0001-90
Setor Comercial Sul, Quadra 03
Brasília — DF — CEP 70304-900
Attn: Sr. Marcos Tavares, Procurement Manager
Tel: +55 (61) 3222-1100
Email: [email protected]
This Quotation Estimate is issued by Dr. Ricardo Almeida, a licensed and board-certified Surgeon operating in Brazil Brasília, to provide a comprehensive and transparent cost breakdown for the surgical and medical services requested by the client. The purpose of this document is to outline the scope of surgical procedures, associated professional fees, facility charges, and ancillary costs that will be incurred in connection with the planned surgical intervention. All pricing presented in this Quotation Estimate reflects current market rates applicable to the Brasília, DF region and is subject to the terms and conditions specified herein.
The Surgeon, Dr. Ricardo Almeida, will perform the following procedures at the Clínica Cirúrgica do Planalto, located in the central district of Brasília, Brazil. The surgical plan has been developed following a thorough pre-operative assessment and consultation conducted on 05 June 2025. The Quotation Estimate below itemizes each component of the surgical engagement:
| # | Description of Service | Quantity | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 1 | Pre-operative consultation and physical examination by the Surgeon | 1 session | R$ 1.200,00 | R$ 1.200,00 |
| 2 | Pre-operative laboratory work (complete blood count, coagulation panel, metabolic panel, urinalysis) | 1 package | R$ 850,00 | R$ 850,00 |
| 3 | Pre-operative imaging (abdominal ultrasound and chest X-ray) | 1 package | R$ 1.100,00 | R$ 1.100,00 |
| 4 | Anesthesiology services (general anesthesia, monitoring, and post-anesthesia care) | 1 procedure | R$ 4.500,00 | R$ 4.500,00 |
| 5 | Surgical procedure: Laparoscopic cholecystectomy performed by the Surgeon | 1 procedure | R$ 12.000,00 | R$ 12.000,00 |
| 6 | Surgical team assistance (two (2) nursing assistants and one (1) scrub nurse) | 1 procedure | R$ 3.200,00 | R$ 3.200,00 |
| 7 | Surgical consumables and implants (trocars, laparoscopic instruments, sutures, drapes) | 1 set | R$ 2.800,00 | R$ 2.800,00 |
| 8 | Operating room facility fee (Clínica Cirúrgica do Planalto, Brasília) | 1 day | R$ 5.500,00 | R$ 5.500,00 |
| 9 | Post-operative hospitalization (24-hour observation in private room) | 1 night | R$ 2.400,00 | R$ 2.400,00 |
| 10 | Post-operative follow-up consultations by the Surgeon (2 visits within 30 days) | 2 visits | R$ 600,00 | R$ 1.200,00 |
| 11 | Post-operative histopathological analysis of excised tissue | 1 sample | R$ 950,00 | R$ 950,00 |
| 12 | Prescribed post-operative medications (analgesics, antibiotics, anti-inflammatories) | 1 course | R$ 480,00 | R$ 480,00 |
| GRAND TOTAL (BRL) | R$ 38.180,00 | |||
The Surgeon named in this Quotation Estimate, Dr. Ricardo Almeida, holds a medical degree from the Universidade de Brasília (UnB) and completed his surgical residency at the Hospital das Clínicas de Brasília. He is registered with the Conselho Regional de Medicina do Distrito Federal (CRM-DF) under number 18.452 and is a Fellow of the American College of Surgeons (FACS). Dr. Almeida has performed over 3,200 laparoscopic procedures in his career and maintains active malpractice insurance coverage through a licensed insurer operating in Brazil. His professional practice is based exclusively in Brasília, DF, and all services described in this Quotation Estimate will be rendered at his registered clinic in the Planalto district.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, all prices are subject to revision based on current market conditions in Brasília, DF.
- All prices are quoted in Brazilian Reais (BRL) and include applicable taxes as mandated by the Federal Revenue Service of Brazil (Receita Federal).
- Payment terms: 50% (fifty percent) of the total amount is due upon acceptance of this Quotation Estimate and scheduling of the procedure. The remaining 50% (fifty percent) is due within five (5) business days following the completion of the surgical procedure and discharge from the facility.
- Accepted payment methods include bank transfer (TED/PIX) to the account of Clínica Cirúrgica do Planalto, or corporate invoice (fatura) with a 30-day net payment cycle for approved corporate clients in Brasília.
- Any additional procedures, complications, or extended hospitalization not foreseen in the original surgical plan will be subject to a supplementary Quotation Estimate issued by the Surgeon prior to or immediately following the additional intervention.
- The Surgeon reserves the right to modify the surgical approach intraoperatively if clinical findings necessitate a change in technique. In such cases, the Surgeon will communicate the modification to the client or their authorized representative as soon as practicable.
- This Quotation Estimate does not constitute a guarantee of surgical outcome. All surgical procedures carry inherent risks, which will be detailed in a separate informed consent document signed by the patient prior to the procedure.
- All medical records, imaging, and histopathological reports generated in connection with the services described herein will be stored in accordance with the data protection regulations of Brazil (Lei Geral de Proteção de Dados — LGPD, Law No. 13.709/2018).
- Disputes arising from this Quotation Estimate shall be resolved under the jurisdiction of the courts of Brasília, DF, Brazil, in accordance with the Brazilian Civil Code.
By signing below, the client acknowledges receipt of this Quotation Estimate for Surgeon services in Brazil Brasília and agrees to the terms, conditions, and pricing outlined in this document. The client further confirms that the surgical plan has been reviewed and that they understand the scope of services to be provided by the Surgeon and his team.
Dr. Ricardo Almeida, MD, FACSSurgeon — Service Provider
CRM-DF 18.452
Date: _______________ Sr. Marcos Tavares
Procurement Manager — Client
Empresa de Saúde Corporativa Ltda.
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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