Quotation Estimate Surgeon in South Africa Cape Town –Free Word Template Download with AI
Cape Town Surgical & Medical Centre (Pty) Ltd
142 Kloof Street, Gardens, Cape Town, 8001, Western Cape, South Africa
Registration No: 2019/456789/07 | HPCSA Practitioner No: 0045678901
Telephone: +27 21 424 5678 | Email: [email protected]
This Quotation Estimate is issued by Cape Town Surgical & Medical Centre (Pty) Ltd to provide Mr. Thabo Nkosi with a comprehensive and transparent financial breakdown for the surgical services to be rendered by our Surgeon, Prof. Dr. Annelise van der Merwe, at our facility located in the Gardens district of Cape Town, South Africa. This document serves as a formal estimate of all anticipated costs associated with the planned surgical procedure, including pre-operative assessments, the operative intervention itself, post-operative care, and any ancillary medical services required during the patient's recovery period in Cape Town.
Following a thorough clinical evaluation conducted on 28 May 2025 at our Cape Town, South Africa facility, the Surgeon has recommended and scheduled the following surgical intervention. This Quotation Estimate reflects the standard fee structure approved by the South African Health Professions Council (HPCSA) and the Medical Schemes Act, 1998, as applicable to private surgical practice in the Western Cape province.
| Ref | Description of Service | Quantity | Unit Cost (ZAR) | Total (ZAR) |
|---|---|---|---|---|
| 1.1 | Pre-operative consultation and clinical assessment by the Surgeon (Cape Town, South Africa) | 1 session | R 2,850.00 | R 2,850.00 |
| 1.2 | Pre-operative diagnostic investigations (blood work, ECG, chest X-ray, anaesthetic assessment) | 1 package | R 4,200.00 | R 4,200.00 |
| 1.3 | Surgeon's operative fee – General & Vascular Surgical Procedure (Theatre time: 3.5 hours) | 1 procedure | R 28,500.00 | R 28,500.00 |
| 1.4 | Assistant Surgeon's fee (Fellow in Surgery, Cape Town Surgical Centre) | 1 procedure | R 8,750.00 | R 8,750.00 |
| 1.5 | Consultant Anaesthetist's fee (General anaesthesia, intra-operative monitoring) | 1 procedure | R 12,400.00 | R 12,400.00 |
| 1.6 | Theatre and facility fees (Operating theatre, recovery room, nursing staff, sterile instruments) | 1 day | R 15,600.00 | R 15,600.00 |
| 1.7 | Inpatient hospital accommodation – Private single room, Cape Town, South Africa (3 nights) | 3 nights | R 4,800.00 | R 14,400.00 |
| 1.8 | Post-operative wound care and dressing changes by the Surgeon's team (2 sessions) | 2 sessions | R 1,200.00 | R 2,400.00 |
| 1.9 | Post-operative follow-up consultation with the Surgeon (Week 2 and Week 6) | 2 sessions | R 1,850.00 | R 3,700.00 |
| 1.10 | Pharmaceuticals and consumables (sutures, dressings, analgesics, antibiotics) | 1 package | R 3,950.00 | R 3,950.00 |
| 1.11 | Pathology and histology laboratory fees (tissue samples, Cape Town reference lab) | 1 package | R 2,300.00 | R 2,300.00 |
| 1.12 | Administrative and documentation fees (surgical report, medical records, HPCSA compliance) | 1 package | R 850.00 | R 850.00 |
| SUBTOTAL (Excluding VAT) | R 99,900.00 | |||
| VAT @ 15% (South Africa) | R 14,985.00 | |||
| GRAND TOTAL (Including VAT) | R 114,885.00 | |||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, the Surgeon and the Cape Town, South Africa facility reserve the right to revise the estimated costs to reflect any changes in pharmaceutical pricing, facility charges, or professional fee adjustments.
- A deposit of 30% (R 34,465.50) of the grand total is required to confirm the surgical booking and secure the theatre slot with the Surgeon. The remaining balance of 70% (R 80,419.50) is payable within seven (7) business days following the completion of the surgical procedure and discharge from the hospital.
- Payment may be made via electronic funds transfer (EFT) to the Cape Town Surgical & Medical Centre (Pty) Ltd account at FNB, Account No: 628451903, Branch: 250655, or by credit card (Visa, Mastercard, or American Express) with a 2.5% surcharge applied.
- Where the patient is covered by a registered South African medical aid scheme, the Surgeon's office will submit the Quotation Estimate and all supporting documentation directly to the medical aid for pre-authorisation. The patient is responsible for any co-payment, gap cover shortfall, or amounts not covered by the scheme.
- All fees quoted in this Quotation Estimate are in South African Rand (ZAR) and are inclusive of the Surgeon's professional expertise, the facility's infrastructure in Cape Town, South Africa, and all standard post-operative care as itemised above.
- In the event of surgical cancellation by the patient within 48 hours of the scheduled procedure, the 30% deposit will be non-refundable. Cancellations made more than 48 hours prior will be refunded in full, less any non-recoverable pre-operative investigation costs.
- This Quotation Estimate does not constitute a guarantee of surgical outcome. The Surgeon will exercise the highest standard of care in accordance with the HPCSA's Code of Professional Conduct and the South African National Health Act, 2003.
- Any disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the Republic of South Africa, and the competent courts of Cape Town, Western Cape shall have exclusive jurisdiction.
I, Prof. Dr. Annelise van der Merwe, hereby confirm that this Quotation Estimate accurately reflects the anticipated costs for the surgical services to be rendered to the above-named patient at our facility in Cape Town, South Africa. I am a registered Specialist Surgeon with the Health Professions Council of South Africa (HPCSA) and a member in good standing of the South African College of Surgeons. I confirm that all fees quoted comply with the current HPCSA fee guidelines and the regulations of the Medical Schemes Act.
Surgeon / Authorising PractitionerProf. Dr. Annelise van der Merwe
Date: ______________________ Patient / Authorised Representative
Mr. Thabo Nkosi
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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