Quotation Estimate Psychiatrist in New Zealand Wellington –Free Word Template Download with AI
142 Lambton Quay, Te Aro, Wellington 6011, New Zealand
Phone: +64 4 472 8830 | Email: [email protected]
Provider Number: 1000123456 | NZQA Registered | HPC (Health Professions Council) Licensed
Quotation Estimate Psychiatrist Consultation & Treatment Services — New Zealand WellingtonQuotation Details
Quotation No.: WMP-2025-04782
Date Issued: 12 June 2025
Valid Until: 12 July 2025 (30 days)
Currency: New Zealand Dollars (NZD)
Client / Patient Details
Name: [Patient Full Name]
NZ Health Card No.: [XXXX-XXXX-XXX]
Address: [Street, Suburb, Wellington, 6011]
Referring GP: Dr. [Name], [Practice], Wellington
Dear [Patient Name],
Thank you for considering the Psychiatrist services offered by Wellington Mind & Wellness Psychiatry Clinic. This Quotation Estimate has been prepared specifically for your care within the New Zealand Wellington region. As a fully licensed and Health Professions Council-registered psychiatric practice, we are committed to delivering evidence-based mental health care tailored to the unique needs of our community here in Wellington. The following Quotation Estimate outlines all anticipated costs associated with your Psychiatrist consultation, diagnostic assessment, and ongoing treatment plan.
Itemised Services & Costs| Ref | Description of Psychiatrist Service | Duration | Frequency | Unit Cost (NZD) | Total (NZD) |
|---|---|---|---|---|---|
| 01 | Initial Psychiatrist Consultation & Comprehensive Psychiatric Assessment (includes medical history review, mental state examination, and diagnostic formulation per DSM-5-TR and ICD-11 criteria) | 60 min | Once | $320.00 | $320.00 |
| 02 | Follow-up Psychiatrist Review Appointments (progress monitoring, medication management, and therapeutic plan adjustment) | 30 min | Monthly x 6 | $185.00 | $1,110.00 |
| 03 | Psychiatric Medication Prescribing & Pharmacological Management (including initial prescription, dose titration, and side-effect monitoring) | Included | Ongoing | $0.00 | $0.00 |
| 04 | Psychological & Neuropsychological Testing (cognitive screening, mood disorder scales, anxiety inventories, and personality assessment) | 90 min | Once | $450.00 | $450.00 |
| 05 | Referral Coordination & GP Communication (written psychiatric report to your referring general practitioner in Wellington, shared care plan documentation) | — | Once | $95.00 | $95.00 |
| 06 | Crisis / Urgent Psychiatrist Telephone Consultation (available 7 days per week within the Wellington metropolitan area) | 20 min | As needed (est. 2) | $120.00 | $240.00 |
| 07 | Annual Psychiatrist Re-assessment & Treatment Plan Renewal (comprehensive review of diagnosis, medication efficacy, and long-term prognosis) | 45 min | Once (Year 1) | $250.00 | $250.00 |
| Estimated Total (NZD, inclusive of GST) | $2,465.00 | ||||
This Quotation Estimate is a good-faith projection of costs for the Psychiatrist services described above, delivered at our clinic in Te Aro, New Zealand Wellington. All fees are quoted in New Zealand Dollars and include the applicable Goods and Services Tax (GST) at the current rate of 15%. Please note that this estimate does not include the cost of prescribed medications, which will be dispensed at your local Wellington pharmacy and may be partially or fully subsidised under the New Zealand Government's Pharmaceutical Schedule. If additional diagnostic imaging, blood work, or specialist referrals (e.g., neurology, endocrinology) are deemed clinically necessary by your treating Psychiatrist, those costs will be itemised in a supplementary Quotation Estimate prior to any additional procedures being undertaken.
Payment Terms & Conditions1. Payment is due within 14 calendar days of the date of this Quotation Estimate or the date of service delivery, whichever is later. We accept EFT, credit card (Visa, Mastercard, AMEX), and direct debit arrangements.
2. A 20% deposit is required to secure your initial Psychiatrist appointment. The remaining balance is payable at the conclusion of each session or as per the agreed payment schedule.
3. Appointments cancelled with less than 48 hours' notice will incur a fee of 50% of the scheduled session cost. No-shows will be charged the full session fee.
4. This Quotation Estimate is valid for 30 days from the date of issue. After the expiry date, fees may be subject to revision in line with the Health Professions Council of New Zealand's recommended fee schedule for Psychiatrist services in the New Zealand Wellington region.
5. All clinical records, psychiatric reports, and treatment documentation are maintained in accordance with the New Zealand Privacy Act 2020 and the Health Information Privacy Code 1994. Your Psychiatrist will not disclose any information without your written consent, except where required by law.
6. In the event of a medical emergency, our Psychiatrist team in Wellington will coordinate with the nearest emergency department (Wellington Hospital, 2 Stanley Street) and your GP. Emergency services are not covered under this Quotation Estimate.
Acceptance of Quotation EstimateBy signing below, the patient (or their authorised legal guardian) acknowledges receipt of this Quotation Estimate for Psychiatrist services in New Zealand Wellington and agrees to the terms, conditions, and estimated costs outlined above.
Patient / Guardian Signature & Date
Clinic Representative (Dr. A. Whitmore, FRANZCP) & Date ⬇️ Download as DOCX Edit online as DOCX
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