Quotation Estimate Surgeon in Saudi Arabia Jeddah –Free Word Template Download with AI

Prepared By:	Dr. Khalid Al-Rashid, Board-Certified Surgeon, Al-Nour Medical Center, Jeddah
Prepared For:	Al-Madina Health & Wellness Group, King Fahd Road, Jeddah, Saudi Arabia
Date of Issue:	15 January 2025
Location of Service:	Jeddah, Saudi Arabia – Al-Nour Medical Center, Al-Salmaniyah District
Currency:	Saudi Riyal (SAR)
Quotation Validity:	45 calendar days from the date of issue

1. Purpose and Scope of This Quotation Estimate

This Quotation Estimate is issued by Dr. Khalid Al-Rashid, a fully licensed and board-certified Surgeon practicing in Saudi Arabia Jeddah, to provide Al-Madina Health & Wellness Group with a comprehensive and transparent breakdown of all professional surgical services, consultations, and related medical support that will be rendered at the Al-Nour Medical Center facility in Jeddah. This document serves as a formal cost projection and is intended to assist the client in budgeting, procurement approval, and financial planning for the upcoming surgical engagement. All figures presented in this Quotation Estimate are exclusive of applicable Value Added Tax (VAT) at the prevailing rate of 15% as mandated by the Zakat, Tax and Customs Authority (ZATCA) of Saudi Arabia.

2. Surgeon Qualifications and Credentials

The Surgeon named in this Quotation Estimate holds a Doctor of Medicine (MD) degree from King Abdulaziz University, Jeddah, followed by a Fellowship in General and Laparoscopic Surgery from the Royal College of Surgeons of Edinburgh. Dr. Al-Rashid is registered with the Saudi Commission for Health Specialties (SCFHS) and maintains an active, unrestricted license to practice surgery in the Kingdom of Saudi Arabia. With over 18 years of clinical experience in Saudi Arabia Jeddah, the Surgeon has performed in excess of 4,200 surgical procedures, including general abdominal surgery, laparoscopic cholecystectomy, hernia repair, and complex bariatric operations. All surgical services described herein will be personally supervised and, where indicated, directly performed by the named Surgeon.

3. Itemized Cost Breakdown

#	Description of Service	Quantity	Unit Rate (SAR)	Total (SAR)	Duration
1	Initial Pre-Operative Consultation and Physical Examination by the Surgeon	1 session	1,500.00	1,500.00	1 hour
2	Pre-Surgical Diagnostic Workup (Blood Panels, Imaging, ECG, Anesthesia Assessment)	1 package	4,200.00	4,200.00	2 days
3	Laparoscopic Cholecystectomy – Primary Surgical Procedure performed by the Surgeon	1 procedure	28,000.00	28,000.00	3–4 hours
4	Operating Room Facility Fee (Theater, Instrumentation, Sterilization) – Al-Nour Medical Center, Jeddah	1 session	6,500.00	6,500.00	4 hours
5	Board-Certified Anesthesiologist Services (General Anesthesia, Intra-operative Monitoring)	1 session	5,000.00	5,000.00	4 hours
6	Post-Operative Hospital Stay (Private Single Room, Nursing Care, Medications)	3 nights	2,800.00	8,400.00	3 days
7	Post-Operative Follow-Up Visits with the Surgeon (Week 1, Week 2, Week 6)	3 visits	800.00	2,400.00	6 weeks
8	Pathology and Histology Analysis of Excised Tissue	1 sample	1,800.00	1,800.00	5–7 days
9	Emergency Contingency Allowance (Reserved for Intra-operative Complications, if any)	1 provision	5,000.00	5,000.00	N/A
10	Medical Records Compilation, Discharge Summary, and SCFHS Compliance Documentation	1 package	600.00	600.00	1 day
Subtotal (SAR)				63,400.00
VAT @ 15% (SAR)				9,510.00
GRAND TOTAL (SAR)				72,910.00

4. Terms and Conditions

This Quotation Estimate is valid for a period of forty-five (45) calendar days from the date of issue. Beyond this period, all rates are subject to revision based on prevailing market conditions in Saudi Arabia Jeddah.
Payment terms: Fifty percent (50%) of the total amount is due upon acceptance of this Quotation Estimate and scheduling of the procedure. The remaining fifty percent (50%) is due within seven (7) business days following the patient's discharge from the facility.
All surgical procedures will be conducted in strict compliance with the regulations set forth by the Saudi Commission for Health Specialties (SCFHS) and the Ministry of Health, Kingdom of Saudi Arabia.
The Surgeon reserves the right to modify the surgical approach intra-operatively if clinical findings necessitate a deviation from the planned procedure. Any additional costs arising from such modifications will be communicated to the patient or authorized representative prior to implementation and will be itemized in a supplementary Quotation Estimate.
The emergency contingency allowance (Item 9) will only be invoiced if actually utilized. Any unspent portion of this allowance will be refunded to the client within fourteen (14) business days post-discharge.
This Quotation Estimate does not include costs for pre-existing condition management, additional imaging beyond the scope listed, or out-of-facility rehabilitation services in Jeddah.
All medical records and surgical reports will be maintained in accordance with Saudi data protection regulations and the patient's right to privacy under the Personal Data Protection Law (PDPL) of Saudi Arabia.
Disputes arising from this Quotation Estimate shall be governed by the laws of the Kingdom of Saudi Arabia and shall be subject to the exclusive jurisdiction of the competent courts in Jeddah.

5. Acceptance and Authorization

By signing below, the client acknowledges receipt of this Quotation Estimate for Surgeon services in Saudi Arabia Jeddah and agrees to the terms, conditions, and cost structure outlined herein. This signature constitutes formal acceptance and authorizes the scheduling of the surgical procedure at Al-Nour Medical Center, Jeddah.

For the Surgeon / Provider
Dr. Khalid Al-Rashid, MD, FRCSE
Al-Nour Medical Center, Jeddah
Date: _______________ For the Client / Authorized Representative
Al-Madina Health & Wellness Group
Name: _______________ Title: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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