Quotation Estimate Ophthalmologist in New Zealand Auckland –Free Word Template Download with AI
Comprehensive Ophthalmologist Services — New Zealand Auckland
Auckland Vision & Ophthalmology Centre42 Karangahape Road, Ponsonby
Auckland 1011, New Zealand
Phone: +64 9 374 5820
Email: [email protected] Provider:
Dr. Sarah Mitchell, FRANZCO
Consultant Ophthalmologist
NZ Medical Council Reg. No. 104829
HIN: 000-482-193
This Quotation Estimate has been prepared by Auckland Vision & Ophthalmology Centre to provide Mr. James T. Henderson with a detailed, itemised financial projection for the full course of ophthalmological care to be delivered by our resident Ophthalmologist in New Zealand Auckland. This document outlines all anticipated diagnostic procedures, therapeutic interventions, surgical options, and follow-up consultations required for the management of bilateral age-related macular degeneration (AMD) and early-stage cataract formation. All pricing is quoted in New Zealand Dollars (NZD) and reflects the current fee schedule as approved by the New Zealand Medical Association and the Auckland District Health Board.
| Ref | Description of Ophthalmologist Service | Quantity | Unit Price (NZD) | Subtotal (NZD) |
|---|---|---|---|---|
| 01 | Initial Comprehensive Ophthalmologist Consultation & History Review (New Zealand Auckland clinic) | 1 | $320.00 | $320.00 |
| 02 | Dilated Fundus Examination with OCT (Optical Coherence Tomography) Imaging | 2 | $185.00 | $370.00 |
| 03 | Fluorescein Fundus Angiography (FFA) — Bilateral | 1 | $450.00 | $450.00 |
| 04 | Anterior Segment Biometry & Cataract Grading (IOL Calculation) | 1 | $210.00 | $210.00 |
| 05 | Anti-VEGF Intravitreal Injection (Ranibizumab) — Right Eye | 6 | $1,250.00 | $7,500.00 |
| 06 | Anti-VEGF Intravitreal Injection (Ranibizumab) — Left Eye | 3 | $1,250.00 | $3,750.00 |
| 07 | Phacoemulsification Cataract Surgery with Premium Toric IOL Implantation (Right Eye) | 1 | $4,800.00 | $4,800.00 |
| 08 | Phacoemulsification Cataract Surgery with Premium Toric IOL Implantation (Left Eye) | 1 | $4,800.00 | $4,800.00 |
| 09 | Post-Operative Ophthalmologist Follow-Up Consultations (Weeks 1, 2, 6, 12) | 4 | $150.00 | $600.00 |
| 10 | Annual Surveillance OCT & Visual Acuity Monitoring (Year 1) | 4 | $120.00 | $480.00 |
| 11 | Prescription of Post-Operative Medications (Antibiotic & Anti-inflammatory drops) | 1 | $95.00 | $95.00 |
| 12 | Low Vision Assessment & Referral Coordination (if required) | 1 | $175.00 | $175.00 |
| TOTAL ESTIMATED COST (NZD) | $23,550.00 | |||
Please note that as a registered resident of New Zealand Auckland, Mr. Henderson may be eligible for partial subsidy of the cataract surgery and anti-VEGF injections through the Auckland District Health Board (ADHB) public health pathway. If the patient elects to proceed via the public system, the Ophthalmologist will coordinate the referral and the Quotation Estimate will be revised to reflect only the out-of-pocket premium IOL surcharge and any non-subsidised ancillary services. The estimated patient contribution under the public pathway would reduce the total to approximately NZD $2,400.00. This Quotation Estimate, however, reflects the full private fee schedule for the most expedited timeline.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, the Ophthalmologist reserves the right to revise pricing in accordance with any changes to the New Zealand Auckland healthcare fee schedule.
- All prices are inclusive of GST (15%) as mandated by the Inland Revenue Department of New Zealand.
- The total cost is an estimate based on the current clinical presentation. Should the Ophthalmologist identify additional pathology during the course of treatment, a supplementary Quotation Estimate will be issued and signed by the patient before any further intervention.
- Payment is due within fourteen (14) days of the date of each individual service invoice. A 2% late-payment surcharge will apply to outstanding balances exceeding thirty (30) days.
- Surgical procedures (Items 07 and 08) require a 50% deposit to secure the operating theatre slot at Auckland City Hospital Private Surgical Unit or the private theatre at Auckland Vision & Ophthalmology Centre.
- This Quotation Estimate does not constitute a guarantee of clinical outcomes. The Ophthalmologist will provide a detailed informed consent document prior to any surgical or interventional procedure.
- All services are delivered in compliance with the Health and Disability Commissioner Act 1994 and the Code of Health and Disability Services Consumers' Rights, New Zealand.
- Any cancellation of a scheduled surgical procedure by the patient within 48 hours of the procedure will incur a cancellation fee of NZD $500.00 per eye.
By signing below, the patient acknowledges receipt of this Quotation Estimate for Ophthalmologist services in New Zealand Auckland and agrees to the terms and conditions outlined herein. This signature does not obligate the patient to proceed with all listed services; it confirms that the patient has reviewed the estimate and accepts the pricing structure for any services subsequently elected.
Dr. Sarah Mitchell, FRANZCOConsultant Ophthalmologist
Auckland Vision & Ophthalmology Centre
Date: _______________ Mr. James T. Henderson
Patient / Authorised Representative
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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