Quotation Estimate Surgeon in Germany Berlin –Free Word Template Download with AI
Professional Surgeon Services — Germany Berlin
1. PARTIES INVOLVEDService Provider (Surgeon)
Name: Dr. Markus Hoffmann, MD, FACS
Clinic: Berliner Chirurgie Zentrum GmbH
Address: Friedrichstraße 142, 10117 Berlin, Germany
Phone: +49 30 5557 8821
Email: [email protected]
VAT ID: DE 312 456 789
Client / Requesting Party
Name: [Client Full Name]
Organization: [Company / Insurance Provider]
Address: [Street, Postal Code, City, Germany]
Phone: [Phone Number]
Email: [Email Address]
Reference No.: [Internal Reference]
2. SCOPE OF SURGEON SERVICES IN GERMANY BERLINThis Quotation Estimate is issued by Dr. Markus Hoffmann, a board-certified Surgeon practising in Germany Berlin, to provide a comprehensive and transparent breakdown of all anticipated costs associated with the requested surgical procedures, pre-operative consultations, post-operative care, and related medical services. The following Quotation Estimate covers the full spectrum of the Surgeon's professional engagement as outlined below. All services will be delivered at the Berliner Chirurgie Zentrum facility located in the central district of Berlin, Germany, in full compliance with the German Medical Association (Bundesärztekammer) regulations and the applicable state medical licensing authority of Berlin.
3. ITEMIZED COST BREAKDOWN| No. | Description of Surgeon Service | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 1 | Initial pre-operative consultation and physical examination by the Surgeon in Berlin, Germany, including review of medical history, imaging studies, and risk assessment | 1 session | € 350.00 | € 350.00 |
| 2 | Pre-operative diagnostic workup: blood panels, ECG, chest X-ray, and anaesthesiology clearance coordinated by the Surgeon's team | 1 package | € 620.00 | € 620.00 |
| 3 | Primary surgical procedure (minimally invasive laparoscopic surgery) performed by the Surgeon, including operating room time, surgical instruments, and disposable materials | 1 procedure | € 4,800.00 | € 4,800.00 |
| 4 | General anaesthesia administered by a certified anaesthesiologist under the Surgeon's supervision, including intra-operative monitoring | 1 session | € 1,200.00 | € 1,200.00 |
| 5 | Post-operative hospital stay (24-hour observation) at Berliner Chirurgie Zentrum, Germany Berlin, including nursing care, medication, and vital monitoring | 1 night | € 950.00 | € 950.00 |
| 6 | Post-operative follow-up visits by the Surgeon (wound inspection, suture removal, recovery assessment) — 3 scheduled appointments within 6 weeks | 3 visits | € 180.00 | € 540.00 |
| 7 | Post-operative imaging (ultrasound or CT scan) to confirm healing and rule out complications, performed at the Berlin facility | 1 scan | € 480.00 | € 480.00 |
| 8 | Prescription medications and post-operative care supplies (antibiotics, analgesics, wound dressings) dispensed through the Berlin clinic pharmacy | 1 package | € 210.00 | € 210.00 |
| 9 | Emergency aftercare hotline access (24/7) for the first 14 days post-surgery, managed by the Surgeon's dedicated care team in Germany Berlin | 14 days | € 150.00 | € 150.00 |
| 10 | Administrative and documentation fees: surgical report, medical records, and official documentation for insurance or employer submission in Germany | 1 set | € 120.00 | € 120.00 |
| SUBTOTAL (before VAT) | € 9,420.00 | |||
| VAT (19% — German standard rate) | € 1,789.80 | |||
| GRAND TOTAL | € 11,209.80 | |||
- Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, all prices listed herein are subject to revision based on current market rates in Germany Berlin and any changes in medical supply costs.
- Payment Terms: A deposit of 30% of the Grand Total (€ 3,362.94) is due upon acceptance of this Quotation Estimate. The remaining 70% (€ 7,846.86) shall be settled within fourteen (14) business days following the completion of all post-operative follow-up visits by the Surgeon.
- Payment Method: Payments may be made via bank transfer to Berliner Chirurgie Zentrum GmbH, IBAN: DE89 3704 0044 0532 0130 00, BIC: COBADEFFXXX, Berlin, Germany. Invoicing will be issued in accordance with German tax law (UStG).
- Scope Limitation: This Quotation Estimate covers only the services explicitly listed in Section 3. Any additional procedures, extended hospital stays, or unforeseen complications requiring re-intervention by the Surgeon will be subject to a separate, supplementary Quotation Estimate issued prior to any additional treatment.
- Insurance: If the client holds statutory health insurance (Gesetzliche Krankenversicherung) or private health insurance (Private Krankenversicherung) in Germany, the applicable insurance coverage will be deducted, and the client will be responsible only for the co-payment (Zuzahlung) as mandated by German health regulations. The Surgeon's office will coordinate directly with the insurer in Berlin.
- Cancellation Policy: Cancellation by the client more than 14 days before the scheduled surgery incurs no charge. Cancellation between 7 and 14 days incurs a fee of 25% of the subtotal. Cancellation within 7 days incurs a fee of 50% of the subtotal. The initial consultation fee (Item 1) is non-refundable once the appointment has taken place.
- Medical Consent: The client acknowledges that the Surgeon will provide a detailed informed consent discussion prior to the procedure, in accordance with the German Civil Code (BGB) § 630d. The client must sign the consent form at least 48 hours before the scheduled surgery date.
- Confidentiality: All medical data and records are handled in strict compliance with the General Data Protection Regulation (GDPR) and the German Federal Data Protection Act (BDSG). No patient information will be disclosed to third parties without explicit written consent.
- Governing Law: This Quotation Estimate and any resulting service agreement shall be governed by and interpreted in accordance with the laws of the Federal Republic of Germany. Any disputes shall be subject to the exclusive jurisdiction of the competent courts in Berlin, Germany.
By signing below, the client acknowledges receipt of this Quotation Estimate for Surgeon services in Germany Berlin, confirms understanding of all terms and conditions, and authorizes the Surgeon and Berliner Chirurgie Zentrum GmbH to proceed with the outlined medical services upon payment of the required deposit.
For the Surgeon / Service Provider
Dr. Markus Hoffmann, MD, FACS
Berliner Chirurgie Zentrum GmbH, Berlin, Germany
Date: ____________________
For the Client / Requesting Party
Name: ____________________
Signature: ____________________
Date: ____________________
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