Estimate of Medical Fees Form

This form may be used by doctors to provide patients with an estimate of medical fees prior to their procedure (or as soon as possible in cases of emergency).

When there is a patient gap, you can use this form to provide written informed financial consent to your patient.

It is crucial to the success of the scheme that your patients are correctly informed of their out-of-pocket expenses.


  • PC Users - If you have difficulty downloading the files, right mouse click on the file link, select 'save target as' and save the document into a local Drive.