BLEPHAROPLASTY QUOTE COMPARISON CHECKLIST
SurgeryViz.com/resources/quote-comparison-checklist

Use one copy for each written quote. Write the practice name and quote date at the top.

PRACTICE / QUOTE
[ ] Practice and clinician:
[ ] Quote date and expiration:
[ ] Procedure and laterality:
[ ] Total written price:

PEOPLE AND SETTING
[ ] Surgeon professional fee
[ ] Anesthesia professional fee
[ ] Facility or operating-room fee
[ ] Accreditation and clinician credentials verified

PROCEDURE SCOPE
[ ] Upper, lower, combined, ptosis, brow, or reconstructive work named
[ ] Laterality and planned technique described
[ ] Included and optional procedures separated
[ ] Revision policy explained in writing

BEFORE AND AFTER CARE
[ ] Consultation and preoperative testing
[ ] Prescriptions, garments, or supplies
[ ] Routine postoperative visits
[ ] After-hours questions or urgent evaluation process

MONEY AND TIMING
[ ] Deposit and payment schedule
[ ] Cancellation and rescheduling terms
[ ] Possible additional charges and who bills them
[ ] Questions answered in a revised written quote

NOTES
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Educational planning only. This worksheet is not a price estimate, recommendation,
insurance determination, or substitute for a written quote and questions answered by
the treating practice.