Quotation Estimate Ophthalmologist in Australia Melbourne –Free Word Template Download with AI
Professional Ophthalmologist Services
Victoria, Australia Melbourne
Quotation No: QTE-2025-MEL-04872Provider Details
Dr. Eleanor Whitfield, FRANZCO
Consultant Ophthalmologist
Melbourne Eye & Vision Centre
Suite 412, Level 4, 120 Collins Street
Melbourne VIC 3000, Australia
ABN: 54 123 456 789
Phone: +61 3 9421 5678
Email: [email protected]
Client Details
Mr. James R. Thompson
Client Reference: CLT-2025-0913
Address: 47 Albert Street
St Kilda, Melbourne VIC 3182
Phone: +61 412 345 678
Email: [email protected]
Medicare Number: On File
Quotation Particulars
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Prepared By: Dr. Eleanor Whitfield
Service Location: Melbourne, Victoria, Australia
Payment Terms
Payment Due: Within 14 days of service
Method: EFT, Credit Card, HICAPS
Medicare Rebate: Applicable where eligible
Private Health: Direct billing available
This Quotation Estimate has been prepared by Dr. Eleanor Whitfield, a fully accredited Ophthalmologist registered with the Australian Health Practitioner Regulation Agency (AHPRA) and the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). The services outlined below are to be delivered at the Melbourne Eye & Vision Centre, located in the heart of Melbourne, Victoria, Australia. This Quotation Estimate covers a comprehensive ophthalmic assessment and treatment plan tailored to the specific clinical needs of the client, in accordance with the standards of practice established for Ophthalmologist services in Australia Melbourne.
| Item No. | Description of Ophthalmologist Service | Quantity | Unit Price (AUD) | Subtotal (AUD) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation – Initial Assessment (includes medical history review, visual acuity testing, and slit-lamp examination) conducted by a senior Ophthalmologist in Melbourne, Australia | 1 | $285.00 | $285.00 |
| 02 | Dilated Fundus Examination and Optical Coherence Tomography (OCT) – performed by the Ophthalmologist to assess retinal health, macular integrity, and optic nerve structure | 1 | $195.00 | $195.00 |
| 03 | Anterior Segment Assessment and Intraocular Pressure Measurement (Gonioscopy and Tonometry) – standard Ophthalmologist diagnostic procedure in Australia Melbourne | 1 | $120.00 | $120.00 |
| 04 | Visual Field Testing (Humphrey Perimetry) – administered under the supervision of the Ophthalmologist to evaluate peripheral vision and detect glaucomatous changes | 1 | $150.00 | $150.00 |
| 05 | Corneal Topography and Pachymetry – advanced Ophthalmologist diagnostic imaging to map corneal curvature and thickness, essential for refractive and cataract planning in Melbourne, Australia | 1 | $175.00 | $175.00 |
| 06 | Follow-up Ophthalmologist Review (6 weeks post-initial assessment) – includes progress evaluation, medication adjustment, and updated treatment plan by the treating Ophthalmologist in Australia Melbourne | 1 | $185.00 | $185.00 |
| 07 | Prescription of Corrective Lenses and Ophthalmic Medications – dispensed through the Melbourne Eye & Vision Centre pharmacy in coordination with the Ophthalmologist's clinical recommendations | 1 | $95.00 | $95.00 |
| 08 | Written Ophthalmologist Report and Referral Documentation – detailed clinical summary prepared by the Ophthalmologist for the client's general practitioner or specialist in Australia Melbourne, including diagnostic findings and management recommendations | 1 | $75.00 | $75.00 |
| Subtotal (AUD) | $1,280.00 | |||
| GST (10%) | $128.00 | |||
| Estimated Medicare Rebate (where applicable) | -$142.50 | |||
| Estimated Net Total (AUD) | $1,265.50 | |||
1. This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, the Ophthalmologist reserves the right to revise pricing in accordance with current Australian Medical Association (AMA) fee schedules applicable to Ophthalmologist services in Australia Melbourne.
2. All fees quoted are in Australian Dollars (AUD) and are inclusive of Goods and Services Tax (GST) at the current rate of 10%, as mandated by the Australian Taxation Office for healthcare providers operating in Melbourne, Victoria.
3. The Medicare rebate amount is an estimate only and is subject to the current Medicare Benefits Schedule (MBS) items applicable to Ophthalmologist consultations and procedures in Australia Melbourne. The client is responsible for any gap between the Ophthalmologist's fee and the Medicare rebate.
4. Private health insurance rebates, where applicable, will be processed directly through the HICAPS terminal at the Melbourne Eye & Vision Centre. The client must present a valid private health insurance card at the time of the Ophthalmologist appointment.
5. Cancellation of any Ophthalmologist appointment must be provided with a minimum of forty-eight (48) hours' notice. Failure to do so may result in a cancellation fee of 50% of the scheduled Ophthalmologist consultation fee, in line with standard practice for Ophthalmologist services in Australia Melbourne.
6. This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. The Ophthalmologist will exercise all reasonable clinical judgement in the delivery of ophthalmic care in accordance with the standards set by the RANZCO and the AHPRA National Board of Ophthalmologists.
7. All patient records, diagnostic imaging, and clinical documentation generated during the Ophthalmologist's assessment will be stored in compliance with the Australian Privacy Act 1988 and the National Privacy Principles applicable to healthcare providers in Melbourne, Australia.
8. This Quotation Estimate is prepared specifically for the named client and is non-transferable. Any additional Ophthalmologist procedures or services not listed herein will be subject to a separate Quotation Estimate or verbal consent at the time of service.
By signing below, the client acknowledges receipt of this Quotation Estimate for Ophthalmologist services in Australia Melbourne and agrees to the terms and conditions outlined above. The Ophthalmologist at the Melbourne Eye & Vision Centre will commence the scheduled ophthalmic assessment upon receipt of a signed copy of this document and confirmation of the first appointment.
Client Signature: ___________________________
Name: Mr. James R. Thompson
Date: ___________________________
Ophthalmologist Signature: ___________________________
Name: Dr. Eleanor Whitfield, FRANZCO
Date: ___________________________
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