Quotation Estimate Dentist in Afghanistan Kabul –Free Word Template Download with AI
Professional Dental Services — Afghanistan Kabul
Reference No: QTE-KBL-2025-0472 | Date of Issue: 15 June 2025 | Valid Until: 15 July 2025
Dental Practice (Provider)
Kabul Comprehensive Dental Clinic
Address: Darulaman District, Kabul, Afghanistan
Phone: +93 700 123 456
Email: [email protected]
License No: AFDL-2024-0089
Client / Patient
Mr. Ahmad Rahimi
Address: Wazir Akbar Khan District, Kabul, Afghanistan
Phone: +93 799 654 321
Email: [email protected]
National ID: 3301-XXXXXX-XX
This Quotation Estimate has been prepared by the Kabul Comprehensive Dental Clinic to provide Mr. Ahmad Rahimi with a comprehensive, itemized breakdown of all anticipated dental treatment costs. As a licensed Dentist operating in Afghanistan Kabul, our practice is committed to delivering transparent pricing, high-quality care, and full compliance with the standards set by the Ministry of Public Health of Afghanistan. This document serves as a formal Quotation Estimate and does not constitute a binding contract until signed and accepted by both parties.
The following Quotation Estimate covers a full-course dental treatment plan as recommended by our lead Dentist following a comprehensive clinical examination conducted on 10 June 2025. All procedures will be performed at our clinic located in Darulaman, Afghanistan Kabul, by a board-certified Dentist with over twelve years of clinical experience in general and restorative dentistry.
| Item No. | Description of Dental Service | Quantity | Unit Price (AFN) | Subtotal (AFN) |
|---|---|---|---|---|
| 01 | Full Oral Examination, Digital X-rays (Panoramic & Periapical), and Diagnostic Consultation by Dentist | 1 | 2,500 | 2,500 |
| 02 | Professional Dental Scaling and Polishing (Ultrasonic & Manual) | 1 | 3,000 | 3,000 |
| 03 | Composite Resin Filling (Posterior Tooth, 2 Surfaces) — per tooth | 3 | 4,500 | 13,500 |
| 04 | Root Canal Treatment (Single-Rooted Tooth) including Post and Core | 1 | 18,000 | 18,000 |
| 05 | Full-Ceramic Crown (Zirconia) — fabrication and cementation | 1 | 35,000 | 35,000 |
| 06 | Extraction of Impacted Third Molar (Wisdom Tooth) under Local Anesthesia | 1 | 8,000 | 8,000 |
| 07 | Post-Operative Follow-Up Visits (2 visits within 30 days) | 2 | 1,000 | 2,000 |
| 08 | Prescription Medications (Antibiotics, Analgesics, Antiseptic Mouthwash) | 1 | 1,500 | 1,500 |
| 09 | Dental Emergency Fund (Reserved for unforeseen complications, 10% contingency) | 1 | 10,000 | 10,000 |
| TOTAL ESTIMATED COST (AFN) | 93,500 | |||
- Advance Payment: A deposit of 30% (AFN 28,050) is required at the time of acceptance of this Quotation Estimate to reserve the treatment schedule with our Dentist.
- Mid-Treatment Payment: 40% (AFN 37,400) is due upon completion of the root canal treatment and prior to crown fabrication.
- Final Payment: The remaining 30% (AFN 28,050) is payable upon final delivery of the ceramic crown and completion of all follow-up visits.
- All payments may be made in Afghan Afghani (AFN) via cash, bank transfer to Kabul Bank (Account: 0045-XXXXXX), or through the HBL Afghanistan mobile payment system.
- The emergency fund (Item 09) will only be charged if complications arise; any unused portion will be refunded within 7 business days.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, prices may be adjusted due to changes in material costs or exchange rates in Afghanistan Kabul.
- All dental procedures will be performed by a qualified Dentist or supervised dental assistant in strict adherence to infection control protocols as mandated by the Ministry of Public Health, Afghanistan.
- The patient agrees to attend all scheduled follow-up appointments. Missed appointments may result in a rescheduling fee of AFN 500.
- Warranty: The zirconia crown carries a 24-month warranty against manufacturing defects. Fillings carry a 12-month warranty. Warranty does not cover damage from trauma, bruxism, or neglect of oral hygiene.
- Confidentiality: All patient records, radiographs, and treatment plans are protected under the Afghanistan Medical Ethics Code. No information will be disclosed without written consent.
- This Quotation Estimate is an estimate only. The final cost may vary by up to 10% if additional procedures are clinically necessary and communicated to the patient in writing before commencement.
- Disputes arising from this Quotation Estimate shall be resolved through the Kabul Medical Disputes Board in Afghanistan Kabul.
By signing below, the patient acknowledges that he has read, understood, and accepts all terms outlined in this Quotation Estimate for dental services provided by the Kabul Comprehensive Dental Clinic in Afghanistan Kabul. The patient confirms that the Dentist has explained the proposed treatment plan, associated risks, and alternative options in a language the patient fully understands.
Patient Signature
Mr. Ahmad Rahimi
Date: _______________
Dentist / Authorized Representative
Dr. Fatima Noori, DDS
Kabul Comprehensive Dental Clinic
Date: _______________
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