Quotation Estimate Doctor General Practitioner in New Zealand Wellington –Free Word Template Download with AI

142 Lambton Quay, Te Aro, Wellington 6011, New Zealand

Phone: +64 4 382 5500 | Email: [email protected]

Provider Number: 100784321 | Ministry of Health Registered

Quotation Estimate

Quotation Reference:	QTE-WGN-2025-04187
Date of Issue:	12 June 2025
Valid Until:	12 July 2025 (30 days)
Prepared For:	Mr. Jonathan A. Whitfield, 8 Khyber Lane, Thorndon, Wellington 6011, New Zealand
Prepared By:	Dr. Sarah M. Callaghan, Doctor General Practitioner, MBChB (Otago), DipGP (NZ)
Service Location:	Wellington Family & General Practice, Te Aro, Wellington, New Zealand

1. Purpose of This Quotation Estimate

This Quotation Estimate has been prepared by Dr. Sarah M. Callaghan, a registered Doctor General Practitioner operating in New Zealand Wellington, to provide Mr. Jonathan A. Whitfield with a comprehensive and transparent breakdown of the anticipated costs associated with a scheduled course of primary healthcare services. This document serves as a formal estimate of fees and is not a binding invoice. All pricing is quoted in New Zealand Dollars (NZD) and reflects the current fee schedule as approved under the New Zealand Health Services Act 1973 and the Ministry of Health Primary Health Care funding guidelines applicable to the Wellington region.

2. Scope of Services – Doctor General Practitioner

The following services are provided by the undersigned Doctor General Practitioner at the Wellington Family & General Practice clinic located in the Te Aro suburb of central Wellington, New Zealand. The Doctor General Practitioner holds full registration with the Medical Council of New Zealand and is an accredited provider under the Primary Health Organisation (PHO) for the Wellington and Hutt Valley region.

Item No.	Description of Service	Duration / Frequency	Estimated Fee (NZD)
01	Initial Comprehensive Consultation – Doctor General Practitioner assessment including full medical history review, physical examination, and discussion of presenting symptoms	1 session / 30 minutes	$125.00
02	Follow-Up Consultation – Doctor General Practitioner review of treatment progress, medication adjustments, and ongoing management plan	2 sessions / 20 minutes each	$180.00
03	Full Blood Panel & Biochemistry – Complete blood count, liver function, renal panel, lipid profile, and fasting glucose ordered by the Doctor General Practitioner	1 set of tests	$145.00
04	Electrocardiogram (ECG) – 12-lead resting ECG performed and interpreted by the Doctor General Practitioner on-site	1 procedure / 15 minutes	$95.00
05	Chronic Disease Management Plan – Ongoing Doctor General Practitioner supervision for hypertension and type 2 diabetes, including quarterly reviews and medication reconciliation	4 reviews over 12 months	$420.00
06	Referral to Specialist – Doctor General Practitioner referral letter and coordination with a cardiologist at Wellington Hospital, including initial liaison and report review	1 referral package	$75.00
07	Preventive Health Check – Annual Doctor General Practitioner wellness assessment including blood pressure monitoring, BMI assessment, lifestyle counselling, and immunisation status review	1 session / 25 minutes	$110.00
08	After-Hours / Weekend Urgent Consultation – Doctor General Practitioner availability for urgent matters outside standard clinic hours (Monday to Friday, 8:00 AM – 5:00 PM)	1 visit / 15 minutes	$165.00

Subtotal (Items 01 – 08):	$1,315.00
Goods and Services Tax (GST) at 15%:	$197.25
Grand Total (NZD):	$1,512.25

3. Payment Terms

Payment for the services outlined in this Quotation Estimate is due within fourteen (14) calendar days of the date of issue. Accepted payment methods include EFTPOS, bank transfer to the Wellington Family & General Practice trust account (ANZ Bank, Account 01-0254-06789123-00), and major credit cards. A 2% late payment surcharge will apply to any balance outstanding beyond the due date. Patients enrolled in a PHO scheme in the Wellington region may be eligible for subsidised rates; the Doctor General Practitioner will confirm eligibility at the time of the initial consultation.

4. Terms and Conditions

1. This Quotation Estimate is valid for thirty (30) days from the date of issue. Fees are subject to revision in accordance with any changes to the New Zealand Ministry of Health fee schedule or the Medical Council of New Zealand's professional fee guidelines.
2. All services are to be delivered by the named Doctor General Practitioner or, in the event of unavailability, by a suitably qualified substitute Doctor General Practitioner at the same Wellington, New Zealand clinic location.
3. Appointments must be booked a minimum of 48 hours in advance. Cancellations made less than 24 hours prior to a scheduled appointment will incur a fee of $50.00 NZD.
4. The Doctor General Practitioner reserves the right to refer the patient to a specialist or hospital service in Wellington, New Zealand, if the clinical condition warrants further investigation beyond the scope of general practice.
5. All patient records and clinical notes are maintained in accordance with the New Zealand Privacy Act 2020 and the Health Information Privacy Code 1994. Records are stored securely at the Te Aro clinic and are accessible to the patient upon written request.
6. This estimate does not include the cost of specialist consultations, hospital admissions, or pharmaceutical prescriptions, which will be itemised separately if applicable.
7. Any additional services requested beyond the scope of this Quotation Estimate will be subject to a revised estimate issued by the Doctor General Practitioner prior to commencement.
8. This Quotation Estimate is governed by the laws of New Zealand. Any disputes arising from the services described herein shall be resolved in the courts of competent jurisdiction in Wellington, New Zealand.

5. Acceptance

By signing below, the patient acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions set forth above. The Doctor General Practitioner will commence the outlined course of care at the Wellington, New Zealand clinic upon receipt of a signed acceptance and the initial consultation deposit of $125.00 NZD.

Prepared by:
Dr. Sarah M. Callaghan
Doctor General Practitioner
Wellington Family & General Practice
Date: ______________________ Accepted by (Patient):
Mr. Jonathan A. Whitfield
Date: ______________________

Wellington Family & General Practice | 142 Lambton Quay, Te Aro, Wellington 6011, New Zealand
This Quotation Estimate was generated on 12 June 2025. For queries, contact the clinic reception on +64 4 382 5500 or email [email protected].
All fees are in New Zealand Dollars (NZD) inclusive of applicable GST where noted. This document is the property of Wellington Family & General Practice and is issued solely for the named patient.

⬇️ Download as DOCX Edit online as DOCX