Quotation Estimate Optometrist in New Zealand Wellington –Free Word Template Download with AI

Wellington Vision & Optometry Centre

Optometrist Practice Address: Level 2, 148 Lambton Quay, Wellington Central, Wellington 6011, New Zealand

Phone: +64 4 472 8830 | Email: [email protected]

Lead Optometrist: Dr. Sarah Mitchell, OD, FCOptom | Registration No: NZOA-2019-4471

Business Number (NZBN): 9429047183625471836

Field	Details
Client Name	Mr. James T. Anderson
Address	27 Khyber Lane, Karori, Wellington 6032, New Zealand
Phone / Email	+64 21 483 9921 / [email protected]
Health Card No.	*---* (on file)
Referring Physician	Dr. L. Chen, Karori Medical Centre, Wellington

This Quotation Estimate has been prepared by our qualified Optometrist team at Wellington Vision & Optometry Centre to provide you with a comprehensive and transparent breakdown of all proposed optometric services, corrective lens options, and associated vision care products. All pricing is quoted in New Zealand Dollars (NZD) and includes applicable Goods and Services Tax (GST) at the current rate of 15%. This Quotation Estimate reflects the standard fee schedule for our New Zealand Wellington practice as of June 2025.

#	Service / Product Description	Qty	Unit Price (NZD)	Subtotal (NZD)
1	Comprehensive Optometrist Eye Examination (includes visual acuity testing, refraction, tonometry, slit-lamp biomicroscopy, and retinal assessment)	1	$245.00	$245.00
2	Advanced Digital Retinal Imaging (OCT – Optical Coherence Tomography) for macular and optic nerve evaluation	1	$185.00	$185.00
3	Binocular Vision & Convergence Assessment (includes near point of convergence, cover testing, and prism adaptation)	1	$95.00	$95.00
4	Progressive Multifocal Lenses – Premium Aspheric (per pair, including lens design and dispensing by our Optometrist)	1	$890.00	$890.00
5	Anti-Reflective, Anti-Scratch, and UV400 Coating Package (applied to both lenses)	1	$120.00	$120.00
6	Frame – Acetate Full-Rim, Designer Collection (selected in-store, Wellington Central showroom)	1	$340.00	$340.00
7	Frame Fitting, Adjustment & Dispensing by Registered Optometrist (includes pupillary distance measurement and vertex distance calibration)	1	$65.00	$65.00
8	Follow-Up Review Appointment (6 weeks post-dispensing, conducted by the same Optometrist)	1	$75.00	$75.00
9	Annual Eye Health Check – Next 12 Months (standard Optometrist re-examination, includes updated refraction and retinal screening)	1	$195.00	$195.00
10	Blue-Light Filtering Digital Screen Coating (add-on to progressive lenses)	1	$85.00	$85.00
Subtotal (excl. GST)				$2,395.00
GST (15%)				$359.25
TOTAL AMOUNT DUE (incl. GST)				$2,754.25

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Upon acceptance, a deposit of 50% (NZD $1,377.13) is required to secure your appointment slot and to commence the lens manufacturing process. The remaining balance is due at the time of final dispensing and fitting. Payment may be made via EFTPOS, bank transfer, or major credit/debit card. Our New Zealand Wellington practice accepts HICAPS for eligible items where applicable under your health insurance policy.

Important Terms & Conditions of This Quotation Estimate

All services are performed by a fully registered Optometrist with the New Zealand Optometrists and Dispensing Opticians Board (NZODOB). Our practice operates in full compliance with the Health and Disability Services Commissioner Act 1993 and the Privacy Act 2020.
This Quotation Estimate is a good-faith estimate of costs. Final pricing may vary slightly if additional clinical findings necessitate supplementary procedures not anticipated at the time of this Quotation Estimate. Any such changes will be communicated and consented to by the client prior to additional work being performed.
Lens manufacturing lead time is typically 7–10 business days for standard progressive lenses. Complex prescriptions (high astigmatism, high minus/plus powers, or specialty tints) may extend this to 14–21 business days.
Our Optometrist provides a 12-month workmanship guarantee on all lens dispensing. If your prescription changes by more than 0.50 dioptres within 12 months, a re-dispensing consultation will be offered at no additional examination fee.
Frame returns are accepted within 14 days of purchase if unused and in original packaging. Lenses, once cut and fitted, are non-returnable due to the customised nature of the product.
This Quotation Estimate does not constitute a medical diagnosis. For any suspected ocular pathology, our Optometrist will refer you to an ophthalmologist at a Wellington hospital or private eye clinic as clinically indicated.
All patient records and imaging data are stored securely in accordance with New Zealand health privacy legislation. You may request access to or correction of your records at any time by contacting our practice office in Wellington Central.
Disputes arising from this Quotation Estimate or the services described herein shall be resolved in accordance with the New Zealand Disputes Tribunal Act 1945 or the Health and Disability Commissioner's office, as appropriate.

By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the itemised services and associated costs, and authorises Wellington Vision & Optometry Centre to proceed with the Optometrist services and lens dispensing as described. The client agrees to the payment terms and conditions outlined above.

Client Signature: ______________________________
Name: Mr. James T. Anderson
Date: ______________________ Optometrist / Authorising Practitioner: ______________________________
Name: Dr. Sarah Mitchell, OD, FCOptom
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX

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