Quotation Estimate Surgeon in India Bangalore –Free Word Template Download with AI

From:
Dr. Arjun Mehta, MS (Ortho), FRCS (Edin)
Senior Surgeon – Apex Surgical Centre
42, Residency Road, Indiranagar
Bangalore, Karnataka – 560038
India
Phone: +91-80-4123-5678
Email: [email protected] Quotation Estimate Date: 15 June 2025
Valid Until: 15 July 2025
Client: Mr. Rajesh Kumar
Client Address: 18, 12th Main, HSR Layout
Sector 2, Bangalore, Karnataka – 560102
India 1. Purpose of This Quotation Estimate

This Quotation Estimate is issued by Dr. Arjun Mehta, a qualified and registered Surgeon practising in India Bangalore, to provide a comprehensive and transparent breakdown of all professional surgical services, associated medical procedures, and ancillary costs for the client named above. This document serves as a formal Quotation Estimate for the planned surgical intervention and post-operative care to be delivered at the Apex Surgical Centre, Bangalore, Karnataka, India. All rates quoted herein are in Indian Rupees (INR) and are subject to the terms and conditions outlined in Section 7 of this Quotation Estimate.

2. Scope of Surgical Services – Surgeon, India Bangalore

The Surgeon engaged under this Quotation Estimate will perform a total knee replacement surgery (TKR) on the right knee, including pre-operative assessment, the surgical procedure itself, immediate post-operative monitoring, and a structured follow-up programme. The Surgeon holds over 18 years of clinical experience in orthopaedic surgery and has performed more than 2,400 successful procedures at facilities across India Bangalore and neighbouring states.

3. Itemised Cost Breakdown

Sr. No.	Service / Item Description	Quantity	Unit Rate (INR)	Total (INR)
1	Pre-operative consultation and clinical assessment by the Surgeon	1	2,500	2,500
2	Diagnostic imaging (X-ray, MRI, CT scan) and laboratory investigations	1	8,500	8,500
3	Surgeon's professional fee for total knee replacement surgery	1	1,20,000	1,20,000
4	Anaesthesiologist fee (general anaesthesia, intra-operative monitoring)	1	15,000	15,000
5	Operating theatre charges (including nursing staff, instruments, and consumables)	1	35,000	35,000
6	Implant cost – cemented total knee replacement prosthesis (imported, India-approved)	1	1,85,000	1,85,000
7	Post-operative hospital stay (private room, 4 nights, including meals and nursing care)	4	6,500	26,000
8	Post-operative medications, dressings, and physiotherapy sessions (10 sessions)	1	18,000	18,000
9	Follow-up consultations by the Surgeon (3 visits over 6 weeks)	3	1,500	4,500
10	Emergency on-call coverage by the Surgeon for 30 days post-discharge	1	5,000	5,000
Subtotal (INR)				4,19,500
GST @ 18% (as applicable in India)				75,510
GRAND TOTAL (INR)				4,95,010

4. Surgeon Credentials and Facility Details – India Bangalore

The Surgeon named in this Quotation Estimate is registered with the Karnataka State Medical Council (Reg. No. KMC/2005/11842) and the National Medical Commission of India. The Apex Surgical Centre, located in the heart of India Bangalore, is NABH-accredited and equipped with state-of-the-art orthopaedic surgical suites, a dedicated recovery unit, and a 24/7 on-call medical team. All surgical procedures conducted under this Quotation Estimate comply with the Medical Council of India (MCI) guidelines and the Karnataka Health Services Act.

5. Payment Terms

As per this Quotation Estimate, the client shall make the following payments:

Advance Payment (50%): INR 2,47,505 – due within 5 working days of acceptance of this Quotation Estimate.
Balance Payment (50%): INR 2,47,505 – due on the day of surgery or prior to the commencement of the anaesthetic procedure.
Payments may be made via bank transfer, UPI, or demand draft to the account details provided on the official invoice issued alongside this Quotation Estimate.

6. Validity and Acceptance

This Quotation Estimate is valid for a period of 30 days from the date of issue (15 June 2025). Beyond this period, the Surgeon reserves the right to revise the rates due to changes in implant pricing, hospital tariff revisions, or regulatory updates in India Bangalore. Acceptance of this Quotation Estimate shall be confirmed in writing by the client or their authorised representative.

7. Terms and Conditions

This Quotation Estimate is a good-faith estimate and does not constitute a binding contract until formally accepted in writing by both parties.
The Surgeon reserves the right to modify the surgical plan intra-operatively if clinical findings necessitate additional procedures. Any such additional costs will be communicated to the client or their family prior to execution and will be itemised separately.
All medical records, operative notes, and post-operative reports generated under this Quotation Estimate shall be the property of the Apex Surgical Centre, Bangalore, and will be made available to the client upon request.
In the event of a medical emergency requiring extended hospitalisation beyond the 4 nights quoted, additional charges will apply at the standard daily rate of INR 6,500 per night, as per the hospital's published tariff in India Bangalore.
This Quotation Estimate does not cover pre-existing conditions unrelated to the planned surgery, cosmetic revisions, or any secondary procedures not explicitly listed herein.
Disputes arising from this Quotation Estimate shall be governed by the laws of India and subject to the exclusive jurisdiction of the courts in Bangalore, Karnataka.
The Surgeon and the facility maintain comprehensive medical malpractice insurance. The client shall be provided with a copy of the insurance policy reference upon request.

8. Declaration

I, Dr. Arjun Mehta, hereby confirm that the rates and services detailed in this Quotation Estimate for Surgeon services in India Bangalore are accurate to the best of my professional knowledge as of the date of issue. I further confirm that all procedures will be carried out in strict adherence to the ethical and clinical standards prescribed by the National Medical Commission of India.

For and on behalf of the Surgeon
Dr. Arjun Mehta, MS (Ortho), FRCS (Edin)
Apex Surgical Centre, Bangalore, India
Date: _______________ Client Acceptance
Mr. Rajesh Kumar
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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