Quotation Estimate Surgeon in South Africa Johannesburg –Free Word Template Download with AI
Professional Surgical Services — South Africa Johannesburg
Ref: QE/SRG/JHB/2025/0417 | Validity: 30 Days from Issue Date
This Quotation Estimate has been prepared by Nkosi Surgical Associates (Pty) Ltd, a registered surgical practice operating in the heart of South Africa Johannesburg, to provide Mr. James P. van der Merwe with a comprehensive and transparent financial breakdown for the proposed surgical intervention. As a licensed Surgeon registered with the Health Professions Council of South Africa (HPCSA), Dr. Nkosi is committed to delivering the highest standard of surgical care in the Johannesburg metropolitan area while ensuring full financial clarity for all patients and their medical aid providers.
The Quotation Estimate below reflects the current fee schedule for 2025 as applicable to surgical procedures performed at the Sandton Private Hospital and the Johannesburg Surgical Centre. All costs are quoted in South African Rand (ZAR) and are subject to the terms and conditions outlined in Section 7 of this document.
Following a thorough clinical assessment conducted on 5 June 2025 at our Johannesburg clinic, the Surgeon has recommended an elective laparoscopic cholecystectomy (removal of the gallbladder) to address the patient's symptomatic cholelithiasis. The procedure is scheduled to take place on 28 June 2025 at the Sandton Private Hospital, Johannesburg, South Africa. The Surgeon will be assisted by a registered surgical team including a scrub nurse, an anaesthesiologist, and a recovery nurse.
| Item Description | Category | Amount (ZAR) |
|---|---|---|
| Surgeon's Professional Fee (Dr. Nkosi) | Medical Professional | R 18,500.00 |
| Assistant Surgeon / Surgical Team Fee | Medical Professional | R 4,200.00 |
| Pre-operative Consultation & Assessment | Medical Professional | R 1,850.00 |
| Post-operative Follow-up Consultations (x2) | Medical Professional | R 2,400.00 |
| Operating Theatre Hire (Sandton Private Hospital) | Facility | R 12,750.00 |
| Laparoscopic Surgical Instruments & Disposables | Materials | R 6,300.00 |
| General Anaesthesia (Anaesthesiologist Fee) | Medical Professional | R 7,800.00 |
| Pre-operative Investigations (Bloods, ECG, Chest X-Ray) | Investigations | R 2,150.00 |
| Inpatient Recovery (1 Night, Private Ward) | Facility | R 5,500.00 |
| Pathology (Tissue Sample Analysis) | Investigations | R 1,200.00 |
| Prescriptions & Post-operative Medication | Materials | R 850.00 |
| Administrative & Hospital Registration Fee | Administrative | R 650.00 |
| TOTAL ESTIMATED COST (ZAR) | R 64,150.00 | |
Based on the patient's Discovery Health plan (Ref: DH-448291) and the current medical aid schedule of benefits for South Africa Johannesburg, the estimated medical aid contribution towards this Quotation Estimate is as follows:
| Description | Amount (ZAR) |
|---|---|
| Estimated Medical Aid Contribution (Discovery Health) | R 42,300.00 |
| Estimated Patient Co-payment / Gap Cover | R 14,850.00 |
| Estimated Out-of-Pocket Liability (Patient) | R 7,000.00 |
Please note that the final medical aid settlement may vary depending on the specific plan benefits, pre-authorisation conditions, and any applicable gap cover policies. The Surgeon's office will submit all claims directly to Discovery Health on behalf of the patient.
Dr. Thabo M. Nkosi is a fully qualified Surgeon with over 18 years of surgical experience in South Africa Johannesburg. He holds a Fellowship of the College of Surgeons of South Africa (FCS) and is registered with the HPCSA under number 0012345678. He has performed over 3,200 laparoscopic procedures and is a senior consultant at both Sandton Private Hospital and the Johannesburg Surgical Centre. His expertise in minimally invasive surgery ensures reduced recovery times, minimal scarring, and superior patient outcomes.
This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Should the patient wish to proceed with the recommended surgical procedure, written acceptance of this Quotation Estimate must be returned to the Surgeon's office no later than 20 June 2025 to secure the operating theatre slot and pre-operative scheduling in Johannesburg.
Important Notes:- All fees are inclusive of VAT (15%) as per South African tax regulations.
- This Quotation Estimate is a good-faith estimate and does not constitute a fixed-price guarantee. Additional costs may arise in the event of intra-operative complications or the need for extended hospitalisation.
- The Surgeon reserves the right to modify the surgical approach intra-operatively if clinical findings warrant a different technique for the patient's safety.
- Pre-authorisation from Discovery Health must be obtained prior to the procedure. The patient is responsible for confirming that their medical aid benefits are active and in good standing.
- Cancellation within 72 hours of the scheduled procedure date will incur a fee of R 5,000.00 to cover theatre and team booking costs.
7.1 This Quotation Estimate is issued by Nkosi Surgical Associates (Pty) Ltd, a company duly registered in the Republic of South Africa, with its principal place of business in Johannesburg, Gauteng.
7.2 The Surgeon and all associated medical professionals are bound by the HPCSA Code of Conduct and the National Health Act (Act No. 61 of 2003) as applicable in South Africa.
7.3 Payment of the patient's out-of-pocket liability is due within 14 days of the procedure. The medical aid portion will be settled directly between the hospital and Discovery Health.
7.4 This Quotation Estimate does not constitute a contract of service until formally accepted in writing by the patient and countersigned by the Surgeon's authorised representative.
7.5 Any disputes arising from this Quotation Estimate shall be subject to the jurisdiction of the courts of South Africa Johannesburg.
Prepared & Signed by:Dr. Thabo M. Nkosi, MBChB, FCS (SA)
Lead Surgeon, Nkosi Surgical Associates (Pty) Ltd
Date: 12 June 2025 Accepted by Patient:
Mr. James P. van der Merwe
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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