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If ‘Yes’, please enter your Health Fund details (Name and Policy number)

Medicare number and position on card

Any other questions or important information you would like to share?

Disclaimer: Please be aware that this is an ESTIMATE ONLY and may change due to variances in the physical condition of each patient (including age and health), the time required for the procedure and other complexities which may arise.

It is important to be aware that this estimate is for Anaesthetic services only and does not cover additional costs associated with your procedure such as surgical charges, hospital fees or any other expenses.

As Medicare and fund item numbers for anaesthesia include a specific item number, and times may vary even for the same procedure, it is only possible to give an estimate of the likely fee. This estimate may vary from the actual fee charged.

I acknowledge that the information I have provided is correct to the best of my knowledge and I have read and understand the information provided the above disclaimer

Allow