Quotation Estimate Surgeon in New Zealand Auckland –Free Word Template Download with AI
128 Federal Street, Ponsonby, Auckland 1011, New Zealand
Phone: +64 9 374 5521 | Email: [email protected]
Provider No: NZ-PS-2024-08871 | IRD: 942-887-551
Quotation EstimateQuotation Details
Quotation No: QTE-AKL-2025-0347
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Margaret Chen, MBChB, FRACS
Specialty: General & Vascular Surgery
Client Information
Client Name: [Patient / Referring Physician Name]
Address: [Street, Suburb, Auckland, New Zealand]
Phone: [Contact Number]
Email: [Email Address]
Referral Source: [GP / Specialist / Self-Referral]
This Quotation Estimate has been prepared by Auckland Surgical Services Ltd. to provide a comprehensive and transparent breakdown of all anticipated costs associated with the engagement of a qualified Surgeon for the planned surgical procedure. This document applies specifically to surgical services delivered within the New Zealand Auckland metropolitan region, in compliance with all regulations set forth by the Medical Council of New Zealand, the Health and Disability Commissioner, and the relevant Auckland District Health Board (now Te Whatu Ora – Auckland). The Surgeon named in this Quotation Estimate holds full registration with the Medical Council of New Zealand and maintains current specialist accreditation in the relevant surgical discipline.
| Ref | Description of Surgeon Service | Unit | Rate (NZD) | Amount (NZD) |
|---|---|---|---|---|
| 01 | Initial Surgeon Consultation & Pre-operative Assessment (New Zealand Auckland clinic, Ponsonby) | 1 session (60 min) | $450.00 | $450.00 |
| 02 | Surgeon Pre-operative Anaesthetic Review & Fasting Protocol Guidance | 1 session (30 min) | $220.00 | $220.00 |
| 03 | Primary Surgical Procedure – Surgeon Fee (Operating Theatre, Auckland Hospital / Private Facility) | 1 procedure | $4,850.00 | $4,850.00 |
| 04 | Assistant Surgeon / First Assistant Fee (if required for complex procedure) | 1 procedure | $1,200.00 | $1,200.00 |
| 05 | Operating Theatre Hire & Surgical Consumables (New Zealand Auckland facility) | 1 block (4 hrs) | $2,340.00 | $2,340.00 |
| 06 | Post-operative Surgeon Review – Day 1 (Wound Check & Discharge Instructions) | 1 session (30 min) | $280.00 | $280.00 |
| 07 | Post-operative Surgeon Review – Week 2 (Suture Removal / Dressing Change) | 1 session (30 min) | $280.00 | $280.00 |
| 08 | Post-operative Surgeon Review – Week 6 (Final Assessment & Rehabilitation Plan) | 1 session (45 min) | $320.00 | $320.00 |
| 09 | Surgeon Telephone / Video Follow-up Consultations (up to 3 calls within 3 months) | 3 calls | $120.00 each | $360.00 |
| 10 | Medical Imaging & Laboratory Tests (Pre-op bloods, X-rays, CT/MRI as indicated) | Package | $680.00 | $680.00 |
| 11 | Surgeon After-hours Emergency Call-out (if required, New Zealand Auckland area) | 1 call (est.) | $550.00 | $550.00 |
| 12 | Medical Report & Documentation (for insurer, ACC, or employer) | 1 report | $180.00 | $180.00 |
| Subtotal (NZD) | $12,710.00 | |||
| GST (15%) | $1,906.50 | |||
| TOTAL ESTIMATED COST (NZD) | $14,616.50 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. All fees are quoted in New Zealand Dollars (NZD) and are subject to the standard 15% Goods and Services Tax (GST) as mandated by the Inland Revenue Department of New Zealand.
- The Surgeon fees listed in this Quotation Estimate are based on the current fee schedule of Auckland Surgical Services Ltd. and are aligned with the New Zealand Medical Association (NZMA) recommended fee guidelines for surgical specialists practising in the New Zealand Auckland region.
- Should the surgical procedure require additional operating time beyond the estimated four-hour block, an additional Surgeon fee of $425.00 per commenced hour will apply, as per the standard New Zealand Auckland private surgical facility rate card.
- Any complications, re-operations, or extended hospital stays necessitating additional Surgeon intervention will be subject to a revised Quotation Estimate issued prior to any further treatment. No additional fees will be charged without prior written consent from the client.
- This Quotation Estimate does not include the cost of inpatient hospital accommodation, anaesthetist fees, physiotherapy, or prescribed medications unless explicitly stated. These costs are typically covered by ACC (Accident Compensation Corporation) or the client's private health insurance provider in New Zealand Auckland.
- All surgical services will be performed in accordance with the Code of Health and Disability Services Consumers' Rights (New Zealand) and the ethical standards of the Medical Council of New Zealand.
- The Surgeon reserves the right to decline or modify the proposed procedure if, during the pre-operative assessment, the clinical findings indicate a different or more appropriate course of treatment. In such cases, a revised Quotation Estimate will be provided at no additional cost.
- Payment terms: A deposit of 30% of the total Quotation Estimate amount is due upon acceptance. The remaining balance is payable within fourteen (14) days of the final post-operative review. Payment may be made via bank transfer, credit card, or direct debit. EFTPOS is available at the New Zealand Auckland clinic.
- This Quotation Estimate is a good-faith estimate and does not constitute a fixed-price contract. Actual costs may vary based on clinical necessity, but any variance exceeding 10% of the total will require written client approval before proceeding.
- For ACC-eligible injuries, the Surgeon and facility will submit claims directly to ACC. The client's out-of-pocket liability in such cases will be limited to any non-ACC-covered items, which will be clearly itemised in a supplementary Quotation Estimate.
By signing below, the client acknowledges that they have read, understood, and accept the terms and conditions outlined in this Quotation Estimate for Surgeon services to be provided in New Zealand Auckland. The client confirms that they have had the opportunity to seek a second opinion and that the Surgeon has explained the nature, risks, and alternatives of the proposed procedure in accordance with New Zealand informed consent requirements.
Client Signature: ___________________________
Print Name: ___________________________
Date: ___________________________
Surgeon / Authorising Practitioner: ___________________________
Dr. Margaret Chen, MBChB, FRACS
Date: ___________________________
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