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Quotation Estimate Surgeon in Japan Kyoto –Free Word Template Download with AI

Professional Surgical Services — Surgeon Consultation & Procedure Package

Kyoto Medical Center — Japan Kyoto

Address: 12-34 Higashiyama-ku, Kyoto 605-0001, Japan

Phone: +81-75-123-4567 | Email: [email protected]

Quotation Estimate No.QTE-KYO-2025-04872
Date of IssueJune 15, 2025
Valid UntilJuly 15, 2025 (30 days from date of issue)
Prepared ForMr. / Ms. [Client Full Name]
Client Address[Client Address], [City], [Country]
Client Contact[Phone Number] | [Email Address]
Prepared ByDr. Kenji Tanaka, Chief of Surgery — Kyoto Medical Center
Service LocationKyoto Medical Center, Japan Kyoto

This Quotation Estimate is issued by Kyoto Medical Center, a fully accredited surgical facility located in the historic city of Japan Kyoto, to provide the client with a comprehensive and transparent breakdown of all costs associated with the engagement of a board-certified Surgeon for the planned medical procedure. This document serves as a formal financial proposal and does not constitute a binding contract until both parties have reviewed, agreed upon, and executed the final service agreement. All figures presented in this Quotation Estimate are denominated in Japanese Yen (JPY) unless otherwise specified, and are subject to the terms and conditions outlined in Section 7 of this document.

The following Quotation Estimate covers the full spectrum of surgical services to be delivered by a senior Surgeon at our facility in Japan Kyoto. The scope includes pre-operative consultation, the surgical procedure itself, post-operative recovery monitoring, and follow-up appointments. The Surgeon assigned to this case will be a board-certified specialist with a minimum of fifteen (15) years of clinical experience, registered with the Japan Medical Association and the Kyoto Prefectural Medical Board. All surgical procedures will be conducted in accordance with the highest standards of medical ethics and clinical practice as mandated by the Japanese Ministry of Health, Labour and Welfare.

Item No. Description of Service Quantity Unit Price (JPY) Total (JPY)
01 Initial Surgeon Consultation & Pre-Operative Assessment (Japan Kyoto facility) 1 session 35,000 35,000
02 Pre-Operative Diagnostic Imaging & Laboratory Panel (CT, MRI, Blood Work) 1 package 120,000 120,000
03 Surgeon Professional Fee — Primary Surgical Procedure (Japan Kyoto operating theatre) 1 procedure 450,000 450,000
04 Anesthesiologist Fee & Anesthesia Administration 1 session 85,000 85,000
05 Operating Theatre & Surgical Equipment Usage (Japan Kyoto facility) 1 session 150,000 150,000
06 Surgical Consumables, Implants & Medication 1 package 95,000 95,000
07 Post-Operative Hospital Stay — Recovery Ward (Japan Kyoto, 3 nights) 3 nights 48,000 144,000
08 Post-Operative Surgeon Follow-Up Consultations (2 sessions within 30 days) 2 sessions 25,000 50,000
09 Medical Records Translation & International Patient Coordination (Japan Kyoto office) 1 package 30,000 30,000
10 Emergency Contingency Fund (Surgeon on-call availability, 72-hour post-op window) 1 package 60,000 60,000
SUBTOTAL 1,219,000
Applicable Tax (10% Consumption Tax, Japan) 121,900
GRAND TOTAL (JPY) 1,340,900

The Surgeon designated for this procedure holds a Doctor of Medicine (M.D.) degree from Kyoto University Faculty of Medicine, a Specialist Certification from the Japanese Surgical Society, and a Fellowship in Advanced Minimally Invasive Surgery. The facility in Japan Kyoto is JCI (Joint Commission International) accredited and operates under the full regulatory oversight of the Kyoto Prefectural Government. All surgical instruments are sterilized to ISO 13485 standards, and the operating theatres are equipped with state-of-the-art robotic-assisted surgical systems. The Surgeon and the entire surgical team will be available for a pre-operative briefing in Japan Kyoto to discuss the procedure, risks, expected outcomes, and recovery timeline in detail with the client or the client's designated medical representative.

As outlined in this Quotation Estimate, payment shall be structured as follows: a non-refundable deposit of 30% (JPY 402,270) is due upon acceptance of this quotation to secure the Surgeon's schedule and the operating theatre in Japan Kyoto. The remaining 70% (JPY 938,630) shall be settled within seven (7) business days following the completion of the surgical procedure and discharge from the recovery ward. Payment may be made via international bank wire transfer to the Kyoto Medical Center account, or by major credit card (Visa, Mastercard, JCB). All transactions are processed in JPY. The client is advised to confirm exchange rates with their financial institution prior to transfer, as this Quotation Estimate does not account for currency conversion fees or international transfer charges.

This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Should the client wish to proceed beyond this validity window, a revised Quotation Estimate reflecting any changes in the Surgeon's availability, facility scheduling, or applicable Japanese medical regulations in Japan Kyoto will be issued at no additional cost. Acceptance of this quotation is confirmed by the client's written signature and the remittance of the initial deposit. Upon acceptance, a formal Service Agreement will be generated, incorporating all terms detailed herein.

  • All surgical procedures are subject to the final medical assessment by the Surgeon in Japan Kyoto. Should the Surgeon determine, in their professional medical judgment, that the planned procedure is not advisable or requires modification, the client will be notified immediately, and this Quotation Estimate will be revised accordingly.
  • The client acknowledges that surgical procedures carry inherent risks. A detailed informed consent form, prepared in both Japanese and English, will be presented to the client prior to the procedure. The Surgeon will walk the client through all potential complications, alternative treatments, and expected recovery milestones.
  • Any additional procedures, extended hospital stays, or unforeseen complications arising during or after the surgery will be billed separately and are not included in this Quotation Estimate. The client will be consulted and given written approval before any additional charges are incurred.
  • Confidentiality of all medical records, imaging, and personal health information is guaranteed under the Japanese Act on the Protection of Personal Information (APPI) and the facility's internal data governance policies in Japan Kyoto.
  • This Quotation Estimate does not include airfare, accommodation in Japan Kyoto outside the hospital recovery ward, personal expenses, or travel insurance. The client is strongly advised to arrange comprehensive medical travel insurance prior to arrival in Japan Kyoto.
  • Disputes arising from this Quotation Estimate or the subsequent Service Agreement shall be governed by the laws of Japan and shall be subject to the exclusive jurisdiction of the courts in Kyoto, Japan.

By signing below, both parties acknowledge that they have read, understood, and agree to all terms, conditions, and cost figures presented in this Quotation Estimate for the engagement of the Surgeon at the Kyoto Medical Center facility in Japan Kyoto.

For Kyoto Medical Center (Japan Kyoto)

Dr. Kenji Tanaka, Chief of Surgery

Signature: ___________________________

Date: ___________________________

For the Client

Name: ___________________________

Signature: ___________________________

Date: ___________________________

Quotation Estimate No. QTE-KYO-2025-04872 | Kyoto Medical Center | Japan Kyoto

This document is the property of Kyoto Medical Center. Unauthorized reproduction or distribution is prohibited.

Generated on June 15, 2025 | Page 1 of 1

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