Quotation Estimate Surgeon in Spain Valencia –Free Word Template Download with AI
Professional Surgical Services – Specialist Surgeon Consultation & Procedures
Valencia, Spain | Comunidad Valenciana
1. Provider InformationMedical Centre: Clínica Mediterránea de Cirugía
Address: Av. de la Constitución, 42, 46003 Valencia, Spain
Telephone: +34 963 555 210
Email: [email protected]
Lead Surgeon: Dr. Alejandro Ferrer Navarro, MD, FACS
Specialty: General & Minimally Invasive Surgery
Registration No.: COLMEV-2019-4472
Licence Authority: Generalitat Valenciana – Conselleria de Sanitat
2. Client / Requesting PartyClient Name: [To be completed]
Address: [To be completed]
Contact Person: [To be completed]
Insurance / Payer: [To be completed]
Policy / Reference No.: [To be completed]
Preferred Language: English / Spanish
3. Scope of Services – Surgeon Engagement in Spain ValenciaThis Quotation Estimate is issued by Clínica Mediterránea de Cirugía, a fully accredited surgical facility located in the city of Spain Valencia, to provide a comprehensive and transparent cost breakdown for the professional services of our designated Surgeon, Dr. Alejandro Ferrer Navarro. The following itemised charges reflect the full scope of surgical care, pre-operative assessment, intra-operative procedures, and post-operative follow-up that the Surgeon will deliver within the facilities and jurisdiction of Spain Valencia.
| Ref | Description of Service | Quantity | Unit Price (€) | Total (€) |
|---|---|---|---|---|
| 01 | Initial consultation and clinical assessment by the Surgeon at the Valencia clinic, including review of medical history, physical examination, and discussion of surgical options. | 1 session | 250.00 | 250.00 |
| 02 | Pre-operative diagnostic work-up: complete blood panel, coagulation profile, ECG, chest X-ray, and anaesthetic clearance performed at the Spain Valencia diagnostic annex. | 1 package | 480.00 | 480.00 |
| 03 | Surgeon's operative fee for the primary surgical procedure (minimally invasive / laparoscopic technique), including anaesthesia coordination and intra-operative decision-making. | 1 procedure | 3,800.00 | 3,800.00 |
| 04 | Operating theatre and equipment usage (endoscopic tower, laparoscopic instruments, sterile draping, and disposable surgical supplies) at the Spain Valencia surgical suite. | 1 block (4 hrs) | 1,200.00 | 1,200.00 |
| 05 | Post-operative inpatient stay (24-hour observation ward) with nursing care, pain management, and daily review by the Surgeon. | 1 night | 650.00 | 650.00 |
| 06 | Post-operative follow-up consultations by the Surgeon (Day 7, Day 14, and Day 30) including wound inspection, suture/staple removal, and recovery assessment. | 3 visits | 120.00 | 360.00 |
| 07 | Pathology and histological analysis of any tissue samples collected during the procedure, processed at the accredited laboratory in Spain Valencia. | 1 sample | 320.00 | 320.00 |
| 08 | Emergency call-back and after-hours availability of the Surgeon for 14 days post-discharge (telephone and in-person). | 14 days | 200.00 | 200.00 |
Subtotal: € 7,260.00
VAT (21% – Spain): € 1,524.60
Grand Total: € 8,784.60
4. Terms and Conditions of This Quotation Estimate- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, all prices are subject to revision based on current market rates in Spain Valencia and updated regulatory fees.
- The Surgeon reserves the right to modify the surgical approach intra-operatively if clinical findings necessitate a change in technique. Any additional costs arising from such modifications will be communicated to the patient or their authorised representative prior to or immediately after the procedure, in accordance with Spanish medical ethics regulations.
- All services described in this Quotation Estimate are to be performed at the Clínica Mediterránea de Cirugía facility in Spain Valencia or at an affiliated hospital within the same municipality, as determined by the Surgeon based on the patient's clinical needs.
- Payment terms: 40% deposit due upon acceptance of this Quotation Estimate to secure the Surgeon's schedule; the remaining 60% is due within seven (7) business days following discharge. Bank transfer to the clinic's designated account in Valencia, Spain.
- This Quotation Estimate does not include costs for additional imaging (MRI, CT), blood transfusions, extended hospitalisation beyond the stated period, or any complications requiring re-intervention. Such items will be quoted separately.
- The Surgeon and the clinic comply with all applicable regulations of the Generalitat Valenciana, the Spanish Ministry of Health, and EU medical device and pharmaceutical directives. All surgical instruments and implants used are CE-marked and traceable.
- Confidentiality of all patient data is guaranteed under the Spanish Organic Law 3/2018 (LOPDGDD) and the EU General Data Protection Regulation (GDPR). Medical records will be stored in the clinic's secure system in Spain Valencia for a minimum of fifteen (15) years.
- Any disputes arising from the services described in this Quotation Estimate shall be subject to the exclusive jurisdiction of the courts of Valencia, Spain.
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the scope of the Surgeon's services to be delivered in Spain Valencia, and authorises the clinic to proceed with scheduling upon receipt of the required deposit.
For Clínica Mediterránea de CirugíaDr. Alejandro Ferrer Navarro, MD, FACS
Lead Surgeon – Spain Valencia
Date: _______________ Client / Authorised Representative
Name: ___________________________
Signature: _______________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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