Invoice Optometrist in Australia Brisbane –Free Word Template Download with AI
Level 3, 123 Queen Street Mall
Brisbane City, Queensland 4000
Australia
Phone: (07) 3000 1234
Email: [email protected]
ABN: 12 345 678 901
AHPRA Registration: OPT-123456789
Invoice Number: INV-2024-0892
Date Issued: 15 January 2024
Due Date: 15 February 2024
Payment Status: Outstanding
Billed To:
Mr. James Thompson
45 River Terrace
New Farm, Queensland 4005
Australia
Phone: 0412 345 678
Email: [email protected]
Medicare Card Number: XXX-XXXX-XXX
Private Health Fund: Bupa Private Health
Policy Number: BUP-987654321
Service Details:
Date of Service: 10 January 2024
Optometrist: Dr. Sarah Mitchell, PhD, FBOptom
Service Type: Comprehensive Eye Examination and Optical Dispensing
Location: Brisbane Vision Care Optometrists, Queen Street Mall, Brisbane CBD
| Item Description | Service Code | Quantity | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|
| Comprehensive Eye Examination including visual acuity testing, refraction, binocular vision assessment, ocular health evaluation, and glaucoma screening | MB-701 | 1 | $180.00 | $180.00 |
| Dilated Fundus Examination with retinal imaging for detailed assessment of posterior segment health | MB-702 | 1 | $95.00 | $95.00 |
| Premier Anti-Reflective Coated Progressive Lenses (Varilux X Series) - Both Eyes | OPT-PL-001 | 1 | $650.00 | $650.00 |
| Designer Titanium Semi-Rimless Frame - Model: Aviator Pro 2024 | OPT-FR-045 | 1 | $320.00 | $320.00 |
| Precision Lens Edging and Frame Fitting Service | OPT-SV-010 | 1 | $45.00 | $45.00 |
| Blue Light Filtering Coating Add-On for Digital Eye Strain Protection | OPT-CO-003 | 1 | $85.00 | $85.00 |
| Low Vision Assessment and Rehabilitation Consultation | MB-705 | 1 | $120.00 | $120.00 |
| Orthokeratology Contact Lens Fitting and Follow-Up (Initial Consultation) | MB-708 | 1 | $250.00 | $250.00 |
| Subtotal: | $1,745.00 |
| GST (10%): | $174.50 |
| Medicare Rebate (Applicable Services): | -$65.00 |
| Private Health Insurance Rebate: | -$150.00 |
| Total Amount Due: | $1,704.50 |
Payment Instructions:
Please remit payment within 30 days of the invoice date to avoid late fees.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
BSB: 062-000
Account Name: Brisbane Vision Care Optometrists Pty Ltd
Account Number: 123456789
Reference: INV-2024-0892
Alternative Payment Methods: Visa, Mastercard, Amex, EFTPOS, or direct payment at our Brisbane CBD clinic.
For Medicare and Private Health Claims: We offer direct claiming facilities at our Brisbane location. Please present your Medicare card and private health fund membership card at the time of service.
Important Notes:
This invoice represents services provided by Brisbane Vision Care Optometrists, a registered optical practice operating in Brisbane, Queensland, Australia. All optometric services are performed by qualified optometrists registered with the Optometry Board of Australia under the Australian Health Practitioner Regulation Agency (AHPRA).
The comprehensive eye examination includes assessment of visual acuity, refractive error, binocular vision function, ocular motility, anterior segment health, intraocular pressure measurement, and dilated fundus examination where clinically indicated. These services align with the Australian Optometry Council's clinical practice guidelines.
Medicare rebates are available for eligible patients under the Medicare Benefits Schedule (MBS) items 701, 702, 705, and 708. The rebate amounts shown are estimates based on current MBS fee schedules and may vary depending on individual eligibility criteria.
Private health insurance rebates are subject to the terms and conditions of your specific policy. We recommend contacting your health fund directly to confirm coverage details for optical services.
All optical products supplied, including lenses and frames, come with a 12-month manufacturer's warranty against defects in materials and workmanship. This warranty is valid throughout Australia and is administered through our Brisbane clinic.
For any queries regarding this invoice, please contact our billing department at (07) 3000 1234 or email [email protected]. Our office is located at Level 3, 123 Queen Street Mall, Brisbane City, Queensland 4000, Australia, and is open Monday to Friday, 9:00 AM to 5:30 PM, and Saturday, 9:00 AM to 1:00 PM.
Thank you for choosing Brisbane Vision Care Optometrists for your eye care needs. We are committed to providing exceptional optometric services to the Brisbane community and surrounding areas in Queensland, Australia.
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