Quotation Estimate Doctor General Practitioner in Australia Melbourne –Free Word Template Download with AI
42 Collins Street, Melbourne VIC 3000, Australia
ABN: 54 123 456 789 | AHPRA Registration: 1234567
Phone: +61 3 9123 4567 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-MEL-0847
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Sarah Mitchell, Doctor General Practitioner
Client / Patient Details
Name: Mr. James Anderson
Address: 18 Swanston Street, Melbourne VIC 3000
Medicare No.: 1234 5678 9012
Phone: +61 4 1234 5678
Dear Mr. Anderson,
Thank you for contacting Melbourne General Practice Medical Centre regarding your ongoing healthcare requirements. This Quotation Estimate has been prepared by our Doctor General Practitioner, Dr. Sarah Mitchell, to outline the comprehensive medical services, consultations, and allied health referrals that will be provided to you as a registered patient of our practice located in the heart of Australia Melbourne. This document serves as a formal estimate of costs and is intended to give you full transparency regarding the financial commitment associated with your care plan over the next twelve (12) months.
As a registered Doctor General Practitioner operating under the Australian Health Practitioner Regulation Agency (AHPRA) and adhering to the Medical Board of Australia's Code of Ethics, I am committed to delivering evidence-based, patient-centred care that meets the highest standards of clinical practice in Australia Melbourne. The services outlined below reflect a tailored care plan developed following your initial comprehensive health assessment conducted on 28 May 2025.
Itemised Services and Estimated Costs| # | Description of Service | Frequency | MBS Item No. | Est. Cost (AUD) | Medicare Rebate |
|---|---|---|---|---|---|
| 1 | Comprehensive General Practitioner Consultation (initial and follow-up) | Quarterly (4x/yr) | 701 | $110.00 | $94.60 |
| 2 | Extended General Practitioner Consultation (complex management) | Bi-annually (2x/yr) | 715 | $165.00 | $141.90 |
| 3 | Annual Health Assessment and Preventive Care Plan | Annually (1x/yr) | 715 | $165.00 | $141.90 |
| 4 | Blood Panel – Full Blood Count, Lipid Profile, HbA1c, Renal & Liver Function | Twice yearly (2x/yr) | 60015 | $185.00 | $120.00 |
| 5 | Electrocardiogram (ECG) – 12-lead | Annually (1x/yr) | 60015 | $95.00 | $60.00 |
| 6 | Referral to Specialist – Cardiology (Melbourne Royal Melbourne Hospital) | As required (est. 1x/yr) | 721 | $150.00 | $100.00 |
| 7 | Referral to Physiotherapist – Lower Back Management Program | 6 sessions | 721 | $480.00 | $300.00 |
| 8 | Medication Management and Prescription Renewals | Monthly (12x/yr) | 701 | $55.00 | $45.00 |
| 9 | After-Hours / Urgent GP Consultation (on-call service, Australia Melbourne) | As required (est. 2x/yr) | 701 | $130.00 | $94.60 |
| 10 | Health Record Management, Care Coordination & Administrative Fees | Annually (1x/yr) | N/A | $200.00 | $0.00 |
| Estimated Total Annual Cost (Patient Out-of-Pocket) | $1,365.60 | $1,298.00 | |||
| Estimated Total Annual Cost (Gross, Pre-Rebate) | $2,663.60 | ||||
- This Quotation Estimate is based on the current Medicare Benefits Schedule (MBS) fee structure as of June 2025 and is subject to annual government adjustments.
- All consultations are conducted by Dr. Sarah Mitchell, a registered Doctor General Practitioner with over 15 years of clinical experience in Australia Melbourne.
- Medicare rebates are indicative and may vary depending on your specific Medicare entitlement, concession status, or private health insurance coverage.
- Specialist and allied health referral costs are estimates based on standard Melbourne metropolitan rates and may vary by provider.
- This Quotation Estimate does not include costs for emergency department visits, hospital admissions, or services outside the scope of general practice.
- Any additional diagnostic imaging (X-ray, ultrasound, CT) will be quoted separately upon clinical necessity.
- All services are delivered in compliance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles.
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After this period, a revised estimate may be required to reflect any changes in MBS fees or service availability.
- Payment for all services is due at the time of consultation unless a payment arrangement has been agreed upon in writing by the practice.
- The Doctor General Practitioner reserves the right to adjust the care plan and associated costs if clinical circumstances change, with prior written notification to the patient.
- Cancellation of booked appointments must be made at least 24 hours in advance to avoid a $50.00 no-show fee, consistent with standard practice policies in Australia Melbourne.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. All treatment is subject to clinical judgement and patient consent.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the Australian Consumer Law and the jurisdiction of the State of Victoria, Australia.
Acceptance of Quotation Estimate: By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the estimated costs and services outlined, and authorises the Doctor General Practitioner at Melbourne General Practice Medical Centre to proceed with the recommended care plan. The patient confirms that all information provided is accurate and that they have had the opportunity to ask questions regarding any aspect of this estimate.
Patient Signature:
Name: Mr. James Anderson
Date: ____________________
Doctor General Practitioner Signature:
Name: Dr. Sarah Mitchell, MBBS, FRACGP
AHPRA Reg. No: 1234567
Date: ____________________
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