Quotation Estimate Psychiatrist in Australia Melbourne –Free Word Template Download with AI

Quotation Estimate No.	QTE-MEL-2025-04871
Date of Issue	12 June 2025
Valid Until	12 July 2025 (30 calendar days)
Prepared By	Dr. Eleanor Whitfield, MBBS, FRANZCP — Lead Psychiatrist, Melbourne Mind Health Clinic
Clinic Address	Suite 4, Level 2, 185 Collins Street, Melbourne VIC 3000, Australia
Contact	Phone: +61 3 9620 4410 \| Email: [email protected]
Prepared For	Mr. James A. Thornton — 2741 Bay Street, St Kilda, Melbourne VIC 3182, Australia

This Quotation Estimate has been prepared by Melbourne Mind Health Clinic to provide Mr. James A. Thornton with a comprehensive, itemised financial outline for the full spectrum of Psychiatrist services to be delivered in Australia Melbourne. The purpose of this document is to ensure complete transparency regarding the scope of psychiatric care, associated professional fees, and all ancillary costs before any treatment plan is initiated. All pricing in this Quotation Estimate is quoted in Australian Dollars (AUD) and reflects the current fee schedule for private psychiatric practice in the Melbourne metropolitan area as of June 2025.

The following services constitute the complete scope of care provided by our Psychiatrist team at Melbourne Mind Health Clinic, located in the heart of Australia Melbourne. Each service has been tailored to the preliminary clinical assessment conducted on 28 May 2025 and is designed to address the patient's diagnosed Generalised Anxiety Disorder (GAD) with comorbid mild depressive episode, as documented in the initial consultation notes.

Ref	Service Description	Frequency / Duration	Unit Rate (AUD)	Quantity	Subtotal (AUD)
01	Initial Comprehensive Psychiatric Assessment — A 90-minute in-person consultation with Dr. Whitfield, Lead Psychiatrist, covering full psychiatric history, mental state examination, risk assessment, and formulation of a treatment plan. Conducted at our Melbourne CBD clinic.	One-time	$420.00	1	$420.00
02	Follow-Up Psychiatrist Consultation — A 45-minute review appointment with the treating Psychiatrist to monitor symptom progression, evaluate medication efficacy, adjust therapeutic interventions, and update the treatment plan. Held at the Melbourne Mind Health Clinic, Collins Street, Australia Melbourne.	Bi-weekly (every 2 weeks)	$285.00	12	$3,420.00
03	Medication Management & Prescription Renewal — Ongoing management of psychotropic medication (including but not limited to SSRIs, benzodiazepines for short-term use, and adjunctive agents) by the Psychiatrist. Includes telephone or secure video review between in-person visits, prescription issuance, and coordination with the patient's general practitioner in Melbourne.	Monthly	$150.00	6	$900.00
04	Psychological Testing & Neuropsychological Battery — Administration and interpretation of standardised psychiatric and neuropsychological assessment tools (e.g., PHQ-9, GAD-7, MMSE, Trail Making Test) to establish baseline cognitive and emotional functioning. Performed by the Psychiatrist and supervised clinical psychologist at our Australia Melbourne facility.	One-time	$350.00	1	$350.00
05	Referral Coordination & Multidisciplinary Case Conference — The Psychiatrist will coordinate referrals to allied health professionals (clinical psychologist, occupational therapist, dietitian) within the Melbourne health network and chair a multidisciplinary case conference to integrate findings into a unified care plan for the patient.	Quarterly	$200.00	2	$400.00
06	After-Hours Psychiatrist Telephone Consultation — Access to an on-call Psychiatrist for urgent clinical queries, medication side-effect management, or crisis de-escalation outside standard business hours (Monday to Friday, 8:30 AM – 5:00 PM, Australia Melbourne time zone AEST/AEDT).	As required (est. 4 calls)	$95.00	4	$380.00
07	Written Psychiatric Report & Medical Certificate — Preparation of a detailed written report by the Psychiatrist summarising diagnosis, treatment course, prognosis, and functional capacity. Suitable for employer, insurance, or medico-legal purposes within Australia.	One-time	$250.00	1	$250.00
08	Annual Psychiatrist Review & Treatment Plan Renewal — A comprehensive 60-minute annual review by the Lead Psychiatrist to reassess diagnosis, evaluate long-term treatment outcomes, update the mental health treatment plan (MHCP) for Medicare rebate eligibility, and plan the subsequent year of care in Australia Melbourne.	Annually	$320.00	1	$320.00

Subtotal (All Psychiatrist Services)					$6,440.00
Medicare Rebate (Estimated, where applicable)					-$1,890.00
Private Health Insurance Contribution (Estimated)					-$1,200.00
Patient Out-of-Pocket Balance (Estimated)					$3,350.00

* Medicare rebate and private health insurance figures are estimates based on current 2025–2026 Australian Government MBS item numbers and standard private health fund psychiatric benefit schedules. Actual rebates may vary. The patient is responsible for any difference between the estimated and actual rebate amounts.

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, all fees are subject to revision in accordance with the current fee schedule of Melbourne Mind Health Clinic and any changes to Australian Government MBS pricing.
All services described in this Quotation Estimate will be delivered by a registered Psychiatrist holding active registration with the Australian Health Practitioner Regulation Agency (AHPRA) and membership of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
Payment for each Psychiatrist consultation and service is due at the time of the appointment. The clinic accepts EFTPOS, bank transfer, and major credit cards. A 24-hour cancellation notice is required to avoid a no-show fee of $150.00 per missed appointment.
Medication prescribed by the Psychiatrist is not included in this Quotation Estimate. Pharmaceutical costs are to be purchased separately at a registered pharmacy in Australia Melbourne and may be partially or fully covered under the patient's private health insurance or the Pharmaceutical Benefits Scheme (PBS).
This Quotation Estimate does not constitute a contract of employment or a guarantee of specific clinical outcomes. The Psychiatrist retains full clinical discretion to modify, extend, or discontinue any element of the treatment plan based on the patient's evolving clinical needs.
All patient records, clinical notes, and psychiatric reports generated in Australia Melbourne are maintained in strict accordance with the Australian Privacy Act 1988 (Cth) and the National Privacy Principles. Records are retained for a minimum of seven (7) years in line with Victorian health record-keeping legislation.
In the event of a clinical emergency, the patient should contact the Melbourne Mind Health Clinic after-hours line or present to the nearest emergency department. Emergency psychiatric care is not covered under this Quotation Estimate and will be billed separately.
This Quotation Estimate is prepared exclusively for the named patient and may not be transferred to a third party without the prior written consent of Melbourne Mind Health Clinic.

By signing below, the patient (or authorised representative) acknowledges receipt of this Quotation Estimate for Psychiatrist services in Australia Melbourne, confirms understanding of the scope of services, associated costs, and terms and conditions outlined herein, and authorises Melbourne Mind Health Clinic to proceed with the proposed treatment plan.

Patient / Authorised Representative

Name: ______________________________

Signature: ______________________________

Date: ______________________________

For Melbourne Mind Health Clinic

Name: Dr. Eleanor Whitfield, MBBS, FRANZCP

Signature: ______________________________

Date: ______________________________

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