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

This Quotation Estimate has been prepared by the Wellington Surgical & Medical Centre to provide Mr. Jonathan R. Whitfield with a comprehensive, itemised financial projection for the surgical procedures, pre-operative assessments, and post-operative care to be delivered by our resident Surgeon team here in New Zealand Wellington. This document serves as a formal Quotation Estimate and does not constitute a binding contract until both parties have executed the acceptance section at the foot of this document. All pricing is quoted in New Zealand Dollars (NZD) and reflects the current fee schedule of the New Zealand Medical Association (NZMA) as applicable to private surgical practice in the Wellington region.

The Surgeon assigned to this case, Dr. Aroha Tane (FRCSC, FRACS, Specialist in General and Laparoscopic Surgery), will oversee the full continuum of care. The following services are included within this Quotation Estimate for the planned laparoscopic cholecystectomy and associated diagnostic workup, to be performed at the Wellington Hospital Private Surgical Wing, located in the heart of New Zealand Wellington:

The Surgeon named in this Quotation Estimate, Dr. Aroha Tane, holds full registration with the Medical Council of New Zealand (MCNZ) and is a Fellow of the Royal Australasian College of Surgeons (FRACS). She has performed over 1,200 laparoscopic cholecystectomies during her 18-year career, the majority of which have been conducted in New Zealand Wellington at both public and private facilities. Her professional indemnity insurance is maintained through the Medical Defence Union (MDU) New Zealand, and all surgical procedures are conducted in full compliance with the Health and Disability Commissioner Act 1993 and the Code of Health and Disability Services Consumers' Rights.

• Validity: This Quotation Estimate is valid for a period of 90 calendar days from the date of issue. Should the client wish to proceed after the expiry date, a revised Quotation Estimate reflecting any changes in the Surgeon's fee schedule or facility costs in New Zealand Wellington will be issued.
• Payment Schedule: A 30% deposit of the total Quotation Estimate amount ($3,201.00) is due upon acceptance to secure the operating theatre and the Surgeon's schedule. The remaining 70% ($7,469.00) is payable within 14 business days of the procedure via bank transfer to the Wellington Surgical & Medical Centre account.
• Health Insurance: If the client holds a private health insurance policy that covers surgical procedures in New Zealand Wellington, the client is responsible for submitting the claim directly to their insurer. This Quotation Estimate may be provided to the insurer as supporting documentation. The Surgeon's fees and facility charges are itemised to facilitate the claims process.
• Scope Changes: Should the Surgeon determine intra-operatively that additional procedures are required (e.g., common bile duct exploration, conversion to open laparotomy), the client's pre-authorised consent (obtained at the pre-operative visit) will cover reasonable additional costs. Any costs exceeding 15% of the original Quotation Estimate will require written consent from the client or their nominated representative prior to commencement.
• Cancellation: Cancellation by the client more than 14 days before the scheduled procedure will result in forfeiture of the deposit only. Cancellation within 14 days will incur a 50% charge of the total Quotation Estimate. Cancellation by the Surgeon or facility due to medical necessity will result in a full refund of all monies paid.
• Governing Law: This Quotation Estimate and any resulting agreement shall be governed by and construed in accordance with the laws of New Zealand, with jurisdiction vested in the District Court of Wellington.
• Confidentiality: All patient information contained within this document is protected under the New Zealand Privacy Act 2020. The Surgeon and all staff at the Wellington Surgical & Medical Centre are bound by strict confidentiality obligations.

By signing below, the client acknowledges that they have read, understood, and accept the terms of this Quotation Estimate for the surgical services to be provided by the named Surgeon in New Zealand Wellington. The client confirms that they have had the opportunity to ask questions regarding the proposed procedure, the Surgeon's qualifications, and the associated costs.