Quotation Estimate Surgeon in Sri Lanka Colombo –Free Word Template Download with AI

This Quotation Estimate has been prepared to provide a comprehensive, transparent, and itemized breakdown of all professional fees, facility charges, and ancillary costs associated with the engagement of a qualified Surgeon for planned surgical intervention. The Surgeon referenced in this document is a board-certified specialist registered with the Medical Secretariat of Sri Lanka and holds active practice privileges at Colombo Medical Centre, located in the heart of Sri Lanka Colombo. This Quotation Estimate is intended for the patient, their family, or the relevant insurance provider to facilitate informed consent, financial planning, and pre-authorization processes prior to the scheduled surgical procedure.

The Surgeon, Dr. Nimal Perera, will provide the following professional services as part of the surgical engagement in Sri Lanka Colombo. All procedures will be conducted in accordance with the standards set by the Sri Lankan Medical Council and the International Society of Surgeons. The Quotation Estimate below reflects the Surgeon's professional fees, operating theatre allocation, anaesthesia support, and post-operative care within the Colombo facility.

• This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Beyond this period, the Surgeon's fees and facility charges in Sri Lanka Colombo are subject to revision based on prevailing medical inflation and institutional rate adjustments.
• The total amount stated in this Quotation Estimate is inclusive of all Surgeon professional fees, theatre charges, anaesthesia, accommodation, and listed consumables. No additional charges will be levied unless the patient provides written consent for procedures outside the originally scoped surgery.
• Payment terms: A non-refundable deposit of 50% (LKR 294,250) is required at the time of accepting this Quotation Estimate to secure the operating theatre slot and the Surgeon's schedule. The remaining 50% balance is due within 48 hours of discharge from the Colombo facility.
• Insurance claims: This Quotation Estimate may be submitted to the patient's health insurance provider for pre-authorization. The Surgeon's office in Sri Lanka Colombo will coordinate directly with the insurer's medical directorate to confirm coverage and any applicable co-payment obligations.
• The Surgeon reserves the right to modify the surgical approach (e.g., converting from laparoscopic to open procedure) if intra-operative findings necessitate it. In such cases, the Surgeon will communicate the revised cost to the patient's authorized representative before proceeding, and this Quotation Estimate will be amended accordingly.
• All medical records, operative notes, and histopathology reports generated during the engagement will be retained at Colombo Medical Centre in compliance with Sri Lankan health data protection regulations. The patient may request a certified copy at any time.
• This Quotation Estimate does not constitute a guarantee of surgical outcome. The Surgeon will provide a detailed risk-benefit discussion during the pre-operative consultation, and the patient must sign a separate informed consent form prior to the procedure.

The Surgeon named in this Quotation Estimate, Dr. Nimal Perera, holds a Bachelor of Medicine and Bachelor of Surgery (MBBS) from the University of Colombo, a Fellowship of the Royal College of Surgeons of Edinburgh (FRCS), and a Fellowship of the American College of Surgeons (FACS). He has over 18 years of surgical practice in Sri Lanka Colombo, with a particular focus on minimally invasive and laparoscopic techniques. Colombo Medical Centre is a JCI-accredited facility equipped with state-of-the-art 4K laparoscopic systems, a dedicated recovery unit, and 24/7 emergency backup.

By signing below, the patient or authorized representative acknowledges receipt of this Quotation Estimate, confirms understanding of all itemized charges for the Surgeon's services in Sri Lanka Colombo, and authorizes the commencement of the pre-operative workup. This signature does not constitute final consent to surgery; a separate surgical consent form will be executed on the day of the procedure.