Quotation Estimate Optometrist in Australia Melbourne –Free Word Template Download with AI
Professional Optometrist Services — Australia Melbourne
Document Ref: QTE-2025-MEL-0847 Prepared By:Dr. Sarah Mitchell, AO
Mitchell Vision Optometry Centre
42 Collins Street, Melbourne VIC 3000
Australia
Phone: +61 3 9421 5678
Email: [email protected] Prepared For:
Mr. James Thornton
18 Harbour Lane, St Kilda
Melbourne VIC 3182
Australia
Phone: +61 4 1234 5678
Email: [email protected] Quotation Date:
12 June 2025
Valid Until:
12 September 2025
Payment Terms:
14 days from invoice
This Quotation Estimate has been prepared by Mitchell Vision Optometry Centre, a registered and accredited Optometrist practice located in the heart of Australia Melbourne, to provide Mr. James Thornton with a comprehensive and transparent breakdown of all professional optometric services, diagnostic assessments, and associated costs. As a licensed Optometrist operating under the Australian Health Practitioner Regulation Agency (AHPRA) and the Optometry Board of Australia, our practice in Australia Melbourne is committed to delivering the highest standard of eye care in accordance with national clinical guidelines.
This Quotation Estimate covers a full comprehensive eye examination, including refraction, anterior and posterior segment assessment, tonometry, visual field testing, and a detailed written report. All services described herein are performed by a qualified Optometrist or under the direct supervision of a senior Optometrist at our Australia Melbourne clinic. Please note that this Quotation Estimate is provided for planning and budgeting purposes and does not constitute a binding contract until formally accepted in writing by both parties.
| Item No. | Description of Service | Quantity | Unit Price (AUD) | Subtotal (AUD) |
|---|---|---|---|---|
| 01 | Comprehensive Optometrist Eye Examination (includes history, refraction, slit-lamp biomicroscopy, and fundus examination) | 1 | $185.00 | $185.00 |
| 02 | Non-Contact Tonometry (Intraocular Pressure Measurement) | 1 | $45.00 | $45.00 |
| 03 | Automated Visual Field Testing (Humphrey 24-2 Standard Threshold) | 1 | $95.00 | $95.00 |
| 04 | Optical Coherence Tomography (OCT) of the Macula and Optic Nerve | 1 | $120.00 | $120.00 |
| 05 | Colour Vision Assessment (Ishihara 38-Plate Test) | 1 | $35.00 | $35.00 |
| 06 | Binocular Vision and Ocular Motility Assessment | 1 | $55.00 | $55.00 |
| 07 | Written Optometrist Clinical Report (suitable for employer, insurer, or medical referral) | 1 | $75.00 | $75.00 |
| 08 | Follow-Up Consultation (within 12 months, Australia Melbourne clinic) | 1 | $95.00 | $95.00 |
| Subtotal (AUD) | $805.00 | |||
| GST (10%) | $80.50 | |||
| TOTAL ESTIMATED COST (AUD, incl. GST) | $885.50 | |||
Please be advised that certain items listed in this Quotation Estimate may be partially or fully covered under the Australian Medicare Benefits Schedule (MBS) or your private health insurance fund, depending on your eligibility, referral status, and specific policy terms. As a registered Optometrist in Australia Melbourne, our practice is Medicare-accredited, and we will process all eligible claims directly on your behalf. The amounts quoted above represent the full professional fee; any rebate received from Medicare or your health fund will be deducted at the point of service, and you will only be responsible for the out-of-pocket balance. We strongly recommend contacting your health insurer prior to the appointment to confirm your exact coverage level.
This Quotation Estimate is valid for a period of ninety (90) days from the date of issue. All prices are quoted in Australian Dollars (AUD) and include Goods and Services Tax (GST) at the current rate of 10%. The Optometrist services described are subject to availability at our Australia Melbourne clinic, and appointment scheduling will be confirmed in writing within two business days of acceptance. Cancellations made less than 24 hours before a scheduled appointment may incur a fee of $50.00. This Quotation Estimate does not guarantee specific clinical outcomes, as all optometric assessments are subject to individual patient response and clinical findings.
Important Note: Should additional diagnostic procedures or specialist referrals be identified during the examination, a supplementary Quotation Estimate will be provided prior to any further treatment or testing. No additional charges will be incurred without your prior written consent.By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions outlined herein. The Optometrist at Mitchell Vision Optometry Centre, Australia Melbourne, will commence the scheduled services upon receipt of a signed acceptance and any required pre-authorisation from the client's health insurance provider.
Client SignatureName: Mr. James Thornton
Date: ______________________ Optometrist / Authorised Representative
Name: Dr. Sarah Mitchell, AO
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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