Invoice Psychiatrist in New Zealand Wellington –Free Word Template Download with AI
Dr. Sarah Jenkins, FRANZCP
Registered Psychiatrist
Medical Council of New Zealand
14 Lambton Quay
Te Aro, Wellington 6011
New Zealand
Phone: +64 4 555 0199
Email: [email protected] From: Wellington Mind & Body Psychiatry
Suite 402, The Terrace Building
123 The Terrace
Wellington Central, Wellington 6011
New Zealand
Phone: +64 4 839 2200
Email: [email protected]
Registered Psychiatrist
Medical Council of New Zealand
INVOICE
Billed To: Mr. James Thompson14 Lambton Quay
Te Aro, Wellington 6011
New Zealand
Phone: +64 4 555 0199
Email: [email protected] From: Wellington Mind & Body Psychiatry
Suite 402, The Terrace Building
123 The Terrace
Wellington Central, Wellington 6011
New Zealand
Phone: +64 4 839 2200
Email: [email protected]
| # | Description of Psychiatric Services | Date | Hours / Qty | Amount (NZD) |
|---|---|---|---|---|
| 1 |
Initial Psychiatric Assessment Comprehensive clinical evaluation including diagnostic formulation, medical history review, and risk assessment conducted at our Wellington Central clinic. Includes initial treatment planning discussion. |
10 Oct 2023 | 1.5 hrs | $450.00 |
| 2 |
Follow-up Consultation (Medication Management) Review of pharmacological treatment efficacy and side effects. Adjustment of prescription regimen. Discussion of progress regarding mood stabilization. |
17 Oct 2023 | 0.5 hrs | $220.00 |
| 3 |
Psychiatric Report for Employer Preparation of a detailed medical report outlining fitness for work and recommended workplace accommodations, compliant with New Zealand employment standards. |
20 Oct 2023 | 1.0 hr | $300.00 |
| 4 |
Telehealth Consultation Secure video consultation regarding acute anxiety management strategies and crisis planning. |
22 Oct 2023 | 0.5 hrs | $220.00 |
| Subtotal: | $1,190.00 |
| ACC Contribution (if applicable): | $0.00 |
| Insurance Rebate (Private): | -$250.00 |
| Total Due: | $940.00 |
Payment Instructions
Please remit payment within 14 days of the invoice date. We accept the following payment methods common in New Zealand:
- Bank Transfer (Preferred):
Bank: ANZ New Zealand
Account Name: Wellington Mind & Body Psychiatry Ltd
Account Number: 01-0022-0334455-00
Reference: INV-WLG-2023-0892 - Credit Card: Visa, Mastercard, and American Express accepted via our secure online portal.
- Cheque: Payable to "Wellington Mind & Body Psychiatry" and mailed to our Wellington address.
Note on ACC: If your condition is related to an accident, please contact us immediately to determine if the Accident Compensation Corporation (ACC) can cover these costs. This invoice assumes private funding or private health insurance.
Terms and Conditions
- Privacy: All patient information is handled in strict accordance with the New Zealand Privacy Act 2020. Your medical records are stored securely in our Wellington facility.
- Cancellation Policy: Appointments cancelled with less than 24 hours' notice may incur a fee of 50% of the consultation rate.
- Prescriptions: Prescriptions are issued at the Psychiatrist's discretion based on clinical need and New Zealand prescribing guidelines.
- Disputes: Any disputes regarding this invoice should be raised in writing within 7 days of receipt.
- Interest: Late payments may incur interest charges at the rate prescribed by the Interest on Money Claims Act 1985.
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