Quotation Estimate Surgeon in United Kingdom London –Free Word Template Download with AI
Professional Surgical Services — United Kingdom London
Thames Valley Surgical Associates Ltd
12 Harley Street, Marylebone, London W1G 9PF, United Kingdom
Tel: +44 (0)20 7946 0000 | Email: [email protected]
Company Reg. No: 08765432 | VAT No: GB 123 4567 89
| Quotation Estimate No: | QTE-2025-LDN-0472 | Date of Issue: | 14 June 2025 |
| Valid Until: | 14 July 2025 (30 days) | Currency: | British Pounds Sterling (GBP £) |
| Prepared For: |
Mr. Jonathan R. Whitfield 48 Kensington Gardens, London W8 7PT, United Kingdom Tel: +44 (0)7700 900123 | Email: [email protected] |
||
| Referring GP: | Dr. Sarah M. Chen, Kensington Medical Practice, London W8 6QF | ||
This Quotation Estimate has been prepared by Thames Valley Surgical Associates Ltd, a registered and fully accredited surgical practice operating in the heart of United Kingdom London, to provide Mr. Jonathan R. Whitfield with a comprehensive and transparent breakdown of all anticipated costs associated with the planned surgical procedure. As a qualified and experienced Surgeon registered with the General Medical Council (GMC) of the United Kingdom, the undersigned Surgeon, Mr. Alistair D. Pemberton, FRCS (Eng), will be overseeing all aspects of the surgical intervention, pre-operative assessment, and post-operative recovery care. This Quotation Estimate reflects the current fee structure applicable to private surgical services delivered in London, United Kingdom, and is subject to the terms and conditions outlined in Section 6 of this document.
2. ITEMISED COST BREAKDOWN| Ref | Description of Service | Quantity | Unit Rate (£) | Total Amount (£) |
|---|---|---|---|---|
| 2.1 | Pre-operative consultation and assessment by the Surgeon (Mr. A. D. Pemberton, FRCS), including full medical history review, physical examination, and discussion of surgical options and risks. Conducted at our Harley Street clinic, London, United Kingdom. | 1 session | 350.00 | 350.00 |
| 2.2 | Pre-operative diagnostic investigations: full blood panel, coagulation screen, ECG, chest X-ray, and anaesthetic pre-assessment. Performed at our affiliated diagnostic centre in Central London, United Kingdom. | 1 package | 420.00 | 420.00 |
| 2.3 | Surgical procedure: Laparoscopic cholecystectomy performed by the Surgeon in a CQC-registered private hospital in London, United Kingdom. Includes operating theatre hire, surgical instruments, and disposable surgical supplies. | 1 procedure | 4,850.00 | 4,850.00 |
| 2.4 | General anaesthesia administered by a consultant anaesthetist. Includes pre-anaesthetic assessment, intra-operative monitoring, and post-anaesthetic recovery care (minimum 2-hour recovery period). | 1 session | 1,200.00 | 1,200.00 |
| 2.5 | Inpatient hospital accommodation: one (1) night in a single private room at the private hospital in London, United Kingdom. Includes meals, nursing care, and inpatient monitoring. | 1 night | 650.00 | 650.00 |
| 2.6 | Post-operative follow-up consultations by the Surgeon: two (2) follow-up appointments at the Harley Street clinic, London, United Kingdom (Day 7 and Week 6 post-surgery), including wound inspection, suture removal, and review of histopathology results. | 2 sessions | 250.00 | 500.00 |
| 2.7 | Post-operative medication and aftercare package: prescribed analgesics, anti-inflammatory medication, wound care supplies, and a 24-hour post-operative telephone helpline for the first 14 days. | 1 package | 185.00 | 185.00 |
| 2.8 | Administrative and documentation fees: preparation of surgical report, discharge summary, and correspondence with the referring GP in London, United Kingdom. Includes digital and hard-copy records. | 1 package | 95.00 | 95.00 |
| Subtotal (excl. VAT): | 8,350.00 | |||
| VAT @ 20% (where applicable): | 1,670.00 | |||
| GRAND TOTAL (incl. VAT): | 10,020.00 | |||
Note: Certain medical and surgical services provided by a registered Surgeon in the United Kingdom may be exempt from VAT under HMRC regulations (VAT Act 1994, Schedule 9, Group 5). The VAT amount shown above is included for completeness and will be adjusted at the point of invoicing based on the final tax classification of each service line item.
3. SURGEON'S PROFESSIONAL DECLARATIONThe Surgeon named in this Quotation Estimate, Mr. Alistair D. Pemberton, FRCS (Eng), holds full and unconditional registration with the General Medical Council of the United Kingdom (GMC No. 7234561) and is a Fellow of the Royal College of Surgeons of England. He has over twenty-two years of dedicated surgical experience, with a particular specialisation in minimally invasive and laparoscopic procedures. All surgical services described in this Quotation Estimate will be performed in strict accordance with the standards set by the Care Quality Commission (CQC), the National Health Service (NHS) England guidelines, and the Royal College of Surgeons' professional code of conduct. The Surgeon confirms that all procedures will be carried out in a CQC-registered facility in London, United Kingdom, meeting the highest standards of patient safety and clinical governance.
4. ASSUMPTIONS AND EXCLUSIONSThis Quotation Estimate is based on the clinical information available at the time of preparation and assumes a straightforward, uncomplicated surgical course. The following items are not included in this Quotation Estimate and would be billed separately should they become necessary:
(a) Any additional surgical procedures or intra-operative findings requiring extended intervention beyond the scope of the planned laparoscopic cholecystectomy;
(b) Extended inpatient hospital stay beyond the single night specified (additional nights at £650.00 per night);
(c) Specialist referrals, additional imaging (CT, MRI, or ultrasound), or further diagnostic tests not listed in item 2.2;
(d) Physiotherapy, occupational therapy, or rehabilitation services post-discharge;
(e) Any costs arising from complications, readmissions, or secondary surgical interventions;
(f) Travel, accommodation, or meal expenses for the patient or accompanying persons in London, United Kingdom.
In accordance with the standard billing practices for private surgical services in United Kingdom London, the payment schedule for this Quotation Estimate is structured as follows:
(a) A non-refundable deposit of 20% (£2,004.00) of the Grand Total is due upon acceptance of this Quotation Estimate to secure the operating theatre slot and hospital bed in London, United Kingdom;
(b) The remaining 80% (£8,016.00) is payable within fourteen (14) calendar days of the date of discharge from the hospital;
(c) Payment may be made by bank transfer to the account details provided on the final invoice, by credit/debit card (Visa, Mastercard, or American Express), or by cheque made payable to "Thames Valley Surgical Associates Ltd";
(d) A late payment surcharge of 1.5% per month will be applied to any outstanding balance after the due date, in line with the Late Payment of Commercial Debts (Interest) Act 1998 applicable in the United Kingdom.
6.1 This Quotation Estimate is valid for a period of thirty (30) days from the date of issue. After this period, the Surgeon reserves the right to revise the fees to reflect any changes in operational costs, hospital tariffs, or regulatory requirements in London, United Kingdom.
6.2 Acceptance of this Quotation Estimate constitutes agreement to the full terms and conditions of Thames Valley Surgical Associates Ltd, a copy of which is available upon request at our Harley Street office in London, United Kingdom.
6.3 The patient acknowledges that all surgical procedures carry inherent risks, and the Surgeon will provide a detailed written consent form outlining all material risks, benefits, and alternative treatments prior to the procedure, in compliance with the Montgomery v Lanarkshire Health Board [2015] UKSC 11 ruling applicable in the United Kingdom.
6.4 This Quotation Estimate does not constitute a guarantee of any specific surgical outcome. The Surgeon will exercise the highest standard of clinical judgement in the best interest of the patient at all times.
6.5 All personal and medical data processed in connection with this Quotation Estimate and the subsequent surgical care will be handled in full compliance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.
6.6 Any disputes arising from this Quotation Estimate or the services described herein shall be governed by the laws of England and Wales and shall be subject to the exclusive jurisdiction of the courts of London, United Kingdom.
7. ACCEPTANCE AND AUTHORISATIONBy signing below, the patient confirms that they have read, understood, and accept the terms of this Quotation Estimate for surgical services to be provided by the Surgeon in United Kingdom London. The patient further confirms that they have had the opportunity to ask questions and seek clarification regarding any aspect of the estimated costs, the surgical procedure, and the associated risks.
For and on behalf of the Surgeon:
Mr. Alistair D. Pemberton, FRCS (Eng)
Lead Surgeon, Thames Valley Surgical Associates Ltd
London, United Kingdom
Patient / Authorised Representative:
Mr. Jonathan R. Whitfield
48 Kensington Gardens, London W8 7PT
United Kingdom
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