Fee Estimate Request Form

To obtain an estimate of the anaesthetic fee for your upcoming procedure, you are encouraged to make contact with us as soon as possible. Please complete the following form and choose submit once you have completed all the fields. Please note that all mandatory fields must be completed.

Estimates will be sent to you via email whenever an email address has been provided and in most cases, we will respond the same business day (Monday to Friday only).

If you are NOT the patient (e.g. parent or guardian), please enter the patient's name and date of birth and your preferred contact details

Title

First name

Surname

Date of birth

Telephone

Email address

Our preferred contact method

Anaesthetist (if known)

Select a Doctor's name from the list (leave blank if unknown)

Surgeon

Description of operation

A brief description of the procedure being done. (Please do not use surgical item numbers.) Please indicate if cosmetic only as GST will apply.

Expected duration

Anaesthetic fees are determined by the duration of your procedure, eg. 60 minutes. Please enter the expected duration if known. Leave blank if unknown.

Operation date

Leave blank if operation date has not yet been confirmed

Hospital

Private health insurance

Yes I do have private health insurance (hospital cover + Medicare) No I do not have private health insurance Overseas insured without Medicare (please enter fund name in the comments section)

Health fund

Leave blank if you are self-funded

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