Quotation Estimate Surgeon in Australia Sydney –Free Word Template Download with AI
Consultant General & Vascular Surgeon
Sydney Surgical Centre, Level 12, 200 George Street, Sydney NSW 2000, Australia
ABN: 48 123 456 789 | AHPRA Registration: 10023456789
Phone: +61 2 9200 4567 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-04871
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared For: Mr. Daniel R. Thompson
Address: 42 Parramatta Road, Leichhardt NSW 2040, Australia
Referral Source: Dr. Sarah Chen, GP – Leichhardt Medical Practice
Procedure Summary
Diagnosis: Inguinal Hernia (Right Side), Grade III
Recommended Procedure: Laparoscopic Inguinal Hernia Repair (TAPP)
Surgeon: Dr. James A. Whitfield, FRACS
Facility: Sydney Surgical Centre, George Street, Sydney
Estimated Duration: 90 minutes operative time
Admission Type: Day Surgery (same-day discharge)
The following Quotation Estimate outlines the professional surgical fees, associated clinical services, and ancillary costs for the recommended procedure to be performed by Dr. Whitfield at the Sydney Surgical Centre, Sydney, Australia. All amounts are quoted in Australian Dollars (AUD) and are subject to the terms and conditions listed below.
| Item | Description of Service | MBS Item No. | Quantity | Amount (AUD) |
|---|---|---|---|---|
| 1 | Pre-operative Surgical Consultation & Assessment (includes physical examination, review of imaging, discussion of surgical options, risks, and informed consent) | 60018 | 1 | $285.00 |
| 2 | Laparoscopic Inguinal Hernia Repair (TAPP) – Primary Surgeon's Fee (Dr. Whitfield, FRACS) | 35510 | 1 | $3,450.00 |
| 3 | Assistant Surgeon's Fee (Dr. Emily Nakamura, FRACS) | 35511 | 1 | $1,200.00 |
| 4 | Pre-operative Anaesthetic Consultation & Assessment (Dr. Michael O'Brien, FANZCA) | 30010 | 1 | $320.00 |
| 5 | General Anaesthesia – Laparoscopic Procedure (up to 90 minutes) | 30012 | 1 | $1,850.00 |
| 6 | Post-operative Surgical Review – Day 1 (telephone or in-person) | 60019 | 1 | $150.00 |
| 7 | Post-operative Surgical Review – Week 2 (wound check, suture removal if applicable) | 60020 | 1 | $185.00 |
| 8 | Surgical Mesh (Polypropylene, 10x15 cm) – Implant Cost | N/A | 1 | $420.00 |
| 9 | Operating Theatre Hire – Sydney Surgical Centre (includes nursing staff, theatre equipment, and consumables) | N/A | 1 | $2,100.00 |
| 10 | Pre-operative Investigations (Full Blood Count, U&E, Coagulation Profile, Chest X-Ray, ECG) | Various | 1 | $380.00 |
| 11 | Post-operative Medication & Wound Care Supplies (analgesics, antibiotic course, dressings) | N/A | 1 | $145.00 |
| 12 | Emergency/Complication Allowance (included in primary surgical fee; no additional charge unless secondary procedure required) | Included | 1 | $0.00 |
| Subtotal (AUD) | $10,485.00 | |||
| GST (10%) | $1,048.50 | |||
| TOTAL QUOTATION ESTIMATE (AUD, incl. GST) | $11,533.50 | |||
Terms & Conditions of This Quotation Estimate
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on current Australian Medical Association (AMA) fee schedules and facility cost adjustments.
- All fees quoted are in Australian Dollars (AUD) and are inclusive of Goods and Services Tax (GST) at the current rate of 10%, as applicable under Australian tax law.
- Where the patient holds a valid Medicare card and/or a private health insurance policy with a surgical benefit, the applicable MBS item numbers listed above will be submitted for rebate. The patient is responsible for any gap between the MBS rebate, the insurer's benefit, and the total fee charged. The estimated out-of-pocket balance for a fully insured patient is approximately $2,800.00 – $3,500.00 AUD, depending on the level of private health cover held.
- This Quotation Estimate covers the surgical procedure as described. It does not include costs for any additional or unforeseen procedures that may become necessary during the operation, pre-existing medical conditions requiring separate management, or extended hospitalisation beyond the expected day-surgery discharge.
- Dr. Whitfield is a Fellow of the Royal Australasian College of Surgeons (FRACS) and is registered with the Australian Health Practitioner Regulation Agency (AHPRA). All surgical services are delivered in compliance with the National Safety and Quality Health Service (NSQHS) Standards and the Australian Commission on Safety and Quality in Health Care (ACSQHC) guidelines.
- The Sydney Surgical Centre is a private, not-for-profit surgical facility located in the Sydney CBD. All theatre and nursing services are provided in accordance with the NSW Health regulations and the Australian Council on Health, Science and Medical Research (ACHR) ethical standards.
- Payment of the full Quotation Estimate amount is due within fourteen (14) days of the date of the procedure, unless a different payment arrangement has been agreed in writing. The patient may elect to pay via bank transfer, credit card, or direct insurance billing where applicable.
- Should the patient wish to cancel the scheduled procedure, a cancellation fee of $500.00 AUD will apply if notice is given less than seven (7) days prior to the scheduled date. No cancellation fee applies for cancellations made more than seven days in advance.
- This Quotation Estimate does not constitute a guarantee of surgical outcome. The patient acknowledges that all surgical procedures carry inherent risks, which have been discussed in detail during the pre-operative consultation. A signed Informed Consent Form must be completed prior to the procedure.
- Any disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the State of New South Wales, Australia. The patient may lodge a complaint with the NSW Health Ombudsman or the Australian Health Practitioner Regulation Agency (AHPRA) if required.
Prepared by:
Dr. James A. Whitfield, FRACS, MD
Consultant Surgeon
Sydney Surgical Centre, Sydney, Australia
Signature: ___________________________
Date: 14 June 2025
Accepted by (Patient / Authorised Representative):
Name: Mr. Daniel R. Thompson
Signature: ___________________________
Date: ___________________________
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