Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

Welcome to Hunter Specialty Anaesthesia

Book a Consult with Dr Rothwell

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On April 13th 2017 by admin

Anaesthetic Quote

Please complete this secure form for your IFC Quote

Patient Name

Patient DOB

Name of person responsible for anaesthetic fees (and relationship if you are not the patient)

Your email

Your phone number

What type of surgery are you having?

If 'Other' , Please specify

Do you know how long the surgery is expected to take?

yesno

If ‘Yes’, please specify

Name of the Hospital where your surgery is taking place

If 'Other' , Please specify

Name of Surgeon

If 'Other' , Please specify

Are you in a private health fund?

yesno

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

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