Quotation Estimate Surgeon in Spain Madrid –Free Word Template Download with AI
Clínica Quirúrgica del Centro, S.L.
Calle de Serrano 142, 28006 Madrid, Spain
Tel: +34 91 555 0142 | Email: [email protected]
NIF: B-87654321 | Healthcare License: CM-2019-04521
Client Information| Client Name: D. Alejandro Fernández Ruiz | NIF/DNI: 48291037-K |
| Address: Av. de América 55, 3ºB, 28028 Madrid, Spain | Contact: +34 612 345 678 |
| Email: [email protected] | Insurance Ref.: MAPFRE-SAL-2025-118934 |
This Quotation Estimate is issued by Clínica Quirúrgica del Centro, S.L., a fully licensed surgical facility located in the heart of Spain Madrid, to provide a comprehensive and transparent breakdown of all anticipated costs associated with the services of our Surgeon team. This document serves as a formal Quotation Estimate for the surgical procedure, pre-operative assessments, and post-operative care to be delivered at our Madrid premises. All pricing reflects current 2025 rates applicable to surgical services in the Spain Madrid metropolitan area and complies with the regulations set forth by the Comunidad de Madrid's healthcare authority (Servicio Madrileño de Salud – SERMAS).
Itemized Cost Breakdown| Ref. | Description of Service | Surgeon / Specialist | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 01 | Initial Surgeon Consultation and Clinical Assessment (includes physical examination, medical history review, and preliminary diagnosis) | Dr. Carmen López Vega – Chief Surgeon | 1 | 250.00 | 250.00 |
| 02 | Pre-operative Diagnostic Imaging (CT Scan, MRI, and Ultrasound) performed at our Spain Madrid facility | Dr. Miguel Torres – Radiology Dept. | 1 | 680.00 | 680.00 |
| 03 | Pre-operative Blood Work and Laboratory Panel (complete metabolic panel, coagulation studies, blood typing) | Clinical Laboratory – Madrid | 1 | 185.00 | 185.00 |
| 04 | General Anaesthesia Administration and Monitoring (per hour, estimated 3 hours) | Dr. Isabel Navarro – Anaesthesiologist | 3 | 320.00 | 960.00 |
| 05 | Primary Surgical Procedure – Open Abdominal Surgery (Surgeon's professional fee, including operative time, surgical instruments, and sterile field preparation) | Dr. Carmen López Vega – Chief Surgeon | 1 | 4,800.00 | 4,800.00 |
| 06 | Assistant Surgeon Fee (second qualified surgeon present during the procedure) | Dr. Pablo Herrera – Assistant Surgeon | 1 | 1,500.00 | 1,500.00 |
| 07 | Operating Room Facility Fee (surgical theatre, nursing staff, equipment sterilization, and consumables) | Clínica Quirúrgica del Centro | 1 | 2,200.00 | 2,200.00 |
| 08 | Post-operative Hospitalization – Private Room (estimated 2 nights, including nursing care, medication, and monitoring) | Clínica Quirúrgica del Centro | 2 | 450.00 | 900.00 |
| 09 | Post-operative Surgeon Follow-up Visits (3 visits within 30 days for wound assessment, suture removal, and recovery evaluation) | Dr. Carmen López Vega – Chief Surgeon | 3 | 120.00 | 360.00 |
| 10 | Pathology and Tissue Analysis (if intra-operative samples are sent for histological examination) | Pathology Lab – Madrid | 1 | 340.00 | 340.00 |
| 11 | Pharmaceuticals and Medical Supplies (anaesthetic agents, antibiotics, analgesics, dressings, and post-operative medication) | Hospital Pharmacy | 1 | 520.00 | 520.00 |
| 12 | Administrative and Documentation Fees (medical records, discharge summary, and insurance billing coordination for Spain Madrid healthcare system) | Administration Office | 1 | 95.00 | 95.00 |
| SUBTOTAL (before VAT) | 12,810.00 | ||||
| VAT (21% – applicable to private surgical services in Spain) | 2,690.10 | ||||
| TOTAL ESTIMATED COST (EUR) | 15,500.10 | ||||
This Quotation Estimate is prepared specifically for the Surgeon services to be rendered at our facility in Spain Madrid. The estimated total of €15,500.10 is based on the current clinical assessment and the standard protocol for the described procedure. Should the Surgeon identify additional complexities during the pre-operative evaluation or intra-operatively, a supplementary Quotation Estimate will be issued and presented to the client or their authorized representative for written approval before any additional services are performed. All prices are quoted in Euros (EUR) and are subject to the standard 21% Value Added Tax (IVA) applicable to private healthcare services in the Comunidad de Madrid. This Quotation Estimate does not constitute a binding contract but rather a good-faith projection of anticipated costs. The final invoice may vary by up to 10% depending on the actual duration of the surgical procedure, the number of consumables utilized, and any unforeseen clinical requirements identified by the Surgeon during the operation.
Terms and Conditions- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on current market rates in Spain Madrid.
- Payment terms: 40% deposit (€6,200.04) due upon scheduling confirmation; 60% balance (€9,300.06) due within fifteen (15) business days following the completion of the surgical procedure and discharge from the facility.
- Accepted payment methods: Bank transfer (IBAN: ES21 0049 0001 5320 1234 5678), credit/debit card (Visa, Mastercard, American Express), or direct insurance settlement where applicable under the client's MAPFRE policy.
- The Surgeon and all medical staff are fully registered with the Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) and hold valid professional liability insurance with a coverage of no less than €3,000,000 per incident.
- All medical records and documentation generated during the course of treatment will be stored in compliance with the Spanish General Data Protection Regulation (RGPD) and the Ley Orgánica 3/2018 de Protección de Datos Personales.
- In the event of a surgical complication requiring extended hospitalization or additional interventions, the client will be notified immediately, and a revised Quotation Estimate will be provided prior to any additional treatment.
- This Quotation Estimate is issued in the city of Spain Madrid and is governed by the civil and commercial laws of the Kingdom of Spain. Any disputes arising from this document shall be subject to the exclusive jurisdiction of the courts of Madrid.
- The client acknowledges that this Quotation Estimate is an estimate only and that the final cost may differ based on clinical findings. The Surgeon reserves the right to modify the surgical plan if clinically indicated, with prior informed consent obtained from the client.
By signing below, the client acknowledges receipt of this Quotation Estimate for Surgeon services in Spain Madrid, confirms understanding of the estimated costs and terms outlined herein, and authorizes Clínica Quirúrgica del Centro, S.L. to proceed with scheduling the described surgical procedure.
Client Signature
D. Alejandro Fernández Ruiz
Date: _______________
Authorized Representative
Dr. Carmen López Vega – Chief Surgeon
Clínica Quirúrgica del Centro, S.L.
Date: _______________
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