Quotation Estimate Surgeon in United Kingdom Birmingham –Free Word Template Download with AI
Surgical Services & Specialist Medical Procedures
Birmingham, United Kingdom
Prepared For (Client)
Name: Mr. James R. Thornton
Address: 47 Edgbaston Crescent, Birmingham, B15 2TN, United Kingdom
NHS Number: 485 772 1930
Contact: 0121 496 8832
Email: [email protected]
Provided By (Surgeon & Facility)
Lead Surgeon: Dr. Eleanor Whitfield, FRCS
Facility: Midlands Surgical Centre
Address: 1200 Colmore Row, Birmingham, B3 2AA
Contact: 0121 643 7700
Email: [email protected]
This Quotation Estimate is issued by Midlands Surgical Centre, a fully CQC-registered private surgical facility located in the heart of Birmingham, United Kingdom, in response to the referral and clinical assessment conducted on 28 May 2025. The Surgeon, Dr. Eleanor Whitfield, has reviewed the patient's medical history, imaging results (MRI and CT scans), and laboratory blood work to determine the appropriate surgical intervention. The following itemised costs reflect the complete package of services required for the planned procedure, including pre-operative assessment, the surgical operation itself, anaesthetic care, inpatient recovery, and post-operative follow-up consultations.
| Ref | Description of Service | Quantity | Unit Price (GBP) | Total (GBP) |
|---|---|---|---|---|
| 01 | Pre-operative medical assessment and consultation with the Surgeon (Dr. Whitfield), including review of imaging, blood tests, and anaesthetic risk evaluation | 1 session | £450.00 | £450.00 |
| 02 | General anaesthetic administration by a consultant anaesthetist, including pre-anaesthetic bloods, monitoring, and post-anaesthetic recovery care | 1 procedure | £1,850.00 | £1,850.00 |
| 03 | Surgical procedure: Laparoscopic cholecystectomy performed by the Surgeon, including theatre time, surgical instruments, disposable implants, and nursing staff | 1 operation | £4,200.00 | £4,200.00 |
| 04 | Inpatient overnight stay in a private single room at Midlands Surgical Centre, Birmingham, including meals, nursing care, and 24-hour monitoring | 1 night | £680.00 | £680.00 |
| 05 | Post-operative follow-up consultation with the Surgeon (wound check, suture/staple removal, and discharge summary), scheduled within 10–14 days of the operation | 1 session | £350.00 | £350.00 |
| 06 | Pathology and histology analysis of excised tissue samples, including written report to the patient and referring GP in Birmingham | 1 sample | £320.00 | £320.00 |
| 07 | Emergency contingency allowance (covers any unforeseen intra-operative complications requiring extended theatre time or additional interventions by the Surgeon) | 1 provision | £500.00 | £500.00 |
| Subtotal | £8,350.00 |
| VAT (20%) | £1,670.00 |
| Grand Total (GBP) | £10,020.00 |
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Should the client wish to proceed after the expiry date, the Surgeon and Midlands Surgical Centre reserve the right to re-assess and issue a revised estimate reflecting any changes in facility costs, staffing, or clinical circumstances.
- All prices are quoted in British Pounds Sterling (GBP) and are inclusive of all standard surgical consumables, theatre staffing, and nursing care within the Birmingham, United Kingdom facility. Any additional procedures not anticipated at the time of this estimate will be discussed with the patient (or their legal representative) prior to commencement, and a supplementary quotation will be provided.
- The Surgeon will perform the operation personally. In the event of a genuine medical emergency preventing Dr. Whitfield from operating, a consultant surgeon of equivalent or greater seniority, registered with the General Medical Council (GMC) and practising in the United Kingdom, will be substituted. The patient will be informed and given the opportunity to reschedule at no additional cost.
- Payment is due within fourteen (14) days of the date of this Quotation Estimate. A 50% deposit is required to secure the theatre slot and inpatient bed at the Birmingham facility. The remaining balance is payable within seven (7) days of discharge. Payment may be made by bank transfer, credit/debit card, or direct debit. A 1.5% surcharge applies to card payments.
- The patient is advised to obtain a pre-operative medical clearance from their GP, who should be located within the Birmingham or West Midlands region, to ensure continuity of post-operative care. The Surgeon will provide a detailed discharge letter to the GP within five working days of the patient's return home.
- Midlands Surgical Centre, Birmingham, United Kingdom, holds full professional indemnity insurance with a cover limit of £10,000,000 per claim. The Surgeon is additionally covered under the Medical Defence Union (MDU) and the British Medical Association (BMA) professional liability schemes.
- This Quotation Estimate does not constitute a guarantee of surgical outcome. The patient acknowledges that all surgical procedures carry inherent risks, which will be discussed in detail during the pre-operative consultation. A written informed consent form, specific to the procedure and the Surgeon's practice, will be signed prior to anaesthesia.
- Any cancellation by the patient within 48 hours of the scheduled operation date will incur a fee of £1,500.00 to cover theatre and staffing costs already committed. Cancellations made more than 48 hours in advance will be charged only the deposit amount, which will be refunded in full if the procedure is rescheduled within three months.
- This document is governed by the laws of England and Wales. Any disputes arising from this Quotation Estimate shall be subject to the exclusive jurisdiction of the courts of Birmingham, United Kingdom.
By signing below, the client confirms that they have read, understood, and accept the terms set out in this Quotation Estimate for the surgical services to be provided by the Surgeon at Midlands Surgical Centre, Birmingham, United Kingdom. The client further confirms that they have had the opportunity to ask questions regarding the procedure, the Surgeon's credentials, and the associated costs.
Client Signature: ___________________________Name: Mr. James R. Thornton
Date: _______________ Surgeon / Authorised Representative: ___________________________
Name: Dr. Eleanor Whitfield, FRCS
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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