Invoice Optometrist in Australia Melbourne –Free Word Template Download with AI
Professional Optometrist Services
Level 4, 123 Collins Street
Melbourne VIC 3000, Australia
Phone: +61 3 9000 1234
Email: [email protected]
ABN: 12 345 678 901
Optometry Board of Australia Registration: OPT-2023-8899
Bill To:
Mr. James Anderson
45 Chapel Street
South Yarra, VIC 3141
Australia
Phone: +61 412 345 678
Patient Details:
Name: Mr. James Anderson
Date of Birth: 15 May 1985
Medicare Number: 1234 567890
Private Health Fund: Bupa Private Health
Policy Number: BUPA-99887766
Member Number: MEM-554433
| # | Description of Optometry Services | Item Code | Qty | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Includes visual acuity testing, refraction, ocular health assessment, and intraocular pressure measurement. Performed by a registered Optometrist in Melbourne. |
OPT-EXAM-01 | 1 | $180.00 | $180.00 |
| 2 |
Advanced Retinal Imaging (Optos) Wide-field retinal photography to detect early signs of diabetic retinopathy, macular degeneration, and glaucoma. Essential for patients over 40 in Australia. |
OPT-IMAG-05 | 1 | $95.00 | $95.00 |
| 3 |
Glaucoma Screening (OCT Scan) Optical Coherence Tomography to measure the thickness of the retinal nerve fiber layer. Critical for monitoring eye health in Melbourne residents. |
OPT-GLAU-02 | 1 | $120.00 | $120.00 |
| 4 |
Pediatric Vision Assessment Specialized eye exam for child (Sarah Anderson, DOB: 12 Jan 2018). Includes amblyopia screening and binocular vision assessment. |
OPT-PEDI-03 | 1 | $150.00 | $150.00 |
| 5 |
Contact Lens Fitting and Assessment Includes corneal topography, lens selection, and follow-up consultation. Compliant with Australian Standards for contact lens practice. |
OPT-CL-04 | 1 | $110.00 | $110.00 |
| 6 |
Low Vision Aids Consultation Assessment and recommendation of magnifiers and electronic aids for age-related vision loss. |
OPT-LV-06 | 1 | $85.00 | $85.00 |
| Subtotal: | $740.00 |
| Medicare Rebate (Estimated): | -$35.00 |
| Private Health Rebate (Estimated): | -$120.00 |
| Discount (Loyalty Member): | -$25.00 |
| Total Due (AUD): | $560.00 |
Payment Instructions:
Please make payment within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge in accordance with Australian commercial law.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
BSB: 062-000
Account Name: Melbourne Vision Specialists Pty Ltd
Account Number: 123456789
Reference: INV-2023-10-459
Credit Card: Visa, Mastercard, and American Express accepted. Please call +61 3 9000 1234 to pay by phone.
Terms and Conditions:
1. All services provided by Melbourne Vision Specialists are performed by fully registered Optometrists in Australia, adhering to the standards set by the Optometry Board of Australia.
2. Medicare rebates are estimates only and subject to change by the Australian Government. Patients are responsible for any difference between the estimated rebate and the actual rebate paid.
3. Private health rebates are estimates based on current fund policies. Patients should verify their coverage with their health fund.
4. Invoices are due within 30 days. If payment is not received by the due date, a reminder notice will be sent. Continued non-payment may result in the account being referred to a debt collection agency.
5. All prices are in Australian Dollars (AUD) and include Goods and Services Tax (GST) where applicable.
6. This invoice is a legal document and should be retained for your records and for any insurance claims.
7. Melbourne Vision Specialists reserves the right to cancel appointments with less than 24 hours' notice. A cancellation fee may apply.
8. For any queries regarding this invoice, please contact our billing department at [email protected] or call +61 3 9000 1234.
Authorized SignatureDr. Emily Chen, Optometrist
Melbourne Vision Specialists Company Stamp
Melbourne Vision Specialists
ABN: 12 345 678 901 ⬇️ Download as DOCX Edit online as DOCX
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