Quotation Estimate Dentist in Algeria Algiers –Free Word Template Download with AI
Quotation Reference No: QE-ALG-2025-04782 | Date of Issue: 15 June 2025 | Valid Until: 15 July 2025
Dentist Services — Algeria Algiers Issued By (Dentist / Clinic):Dr. Amine Benali, D.D.S.
Clinique Dentaire du Centre — Algiers
42, Rue Didouche Mourad, Hydra
Algiers 16000, Algeria
Tel: +213 (0) 23 45 67 89
Email: [email protected]
NIF: 0999 1234 5678 Prepared For (Client):
Mr. Karim Haddad
18, Rue Hassiba Ben Bouali
Bab El Oued, Algiers 13000
Algeria
Tel: +213 (0) 550 12 34 56
Email: [email protected]
1. Purpose of This Quotation Estimate
This Quotation Estimate has been prepared by the undersigned Dentist, Dr. Amine Benali, operating the Clinique Dentaire du Centre located in the city of Algiers, Algeria, to provide Mr. Karim Haddad with a comprehensive and transparent financial breakdown of the proposed dental treatment plan. This document serves as a formal Quotation Estimate outlining all anticipated costs, procedures, timelines, and conditions associated with the dental care to be delivered in Algiers, Algeria. The client is advised to review this Quotation Estimate in its entirety before authorizing any dental procedures.
2. Scope of Dental Services (Dentist Procedures)
Following a thorough clinical examination conducted at our Algiers, Algeria clinic on 10 June 2025, the following dental treatment plan has been recommended by the treating Dentist. Each procedure below represents a distinct service component included in this Quotation Estimate:
| Ref. | Dental Procedure / Service | Description | Qty | Unit Price (DZD) | Subtotal (DZD) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral examination, panoramic radiograph, and periapical X-rays (4 views) | 1 | 8,500 | 8,500 |
| 02 | Ultrasonic Scaling & Polishing (Prophylaxis) | Removal of calculus and plaque deposits, followed by professional polishing | 1 | 12,000 | 12,000 |
| 03 | Composite Resin Filling (Tooth #14) | Restoration of a Class II carious lesion with light-cured composite material | 1 | 18,000 | 18,000 |
| 04 | Root Canal Treatment (Tooth #21) | Endodontic therapy including access, canal preparation, obturation, and temporary restoration | 1 | 45,000 | 45,000 |
| 05 | Full-Ceramic Crown (Tooth #21) | Custom-fabricated zirconia crown, including impression, try-in, and cementation | 1 | 65,000 | 65,000 |
| 06 | Extraction of Impacted Wisdom Tooth (Tooth #48) | Surgical extraction under local anesthesia with suturing and post-operative instructions | 1 | 35,000 | 35,000 |
| 07 | Follow-Up Consultations (Post-Operative) | Two scheduled follow-up visits for suture removal and healing assessment | 2 | 3,500 | 7,000 |
| 08 | Prescribed Medications & Post-Operative Kit | Antibiotics, analgesics, antiseptic mouthwash, and soft-bristle toothbrush | 1 | 6,500 | 6,500 |
3. Financial Summary of This Quotation Estimate
| Subtotal (All Dental Procedures) | 197,000.00 DZD |
| VAT (19% — Applicable per Algerian Tax Code) | 37,430.00 DZD |
| TOTAL AMOUNT DUE (Quotation Estimate) | 234,430.00 DZD |
* All prices are quoted in Algerian Dinars (DZD). This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to revision should the scope of dental treatment change following further clinical assessment by the Dentist.
4. Terms and Conditions
- This Quotation Estimate is a non-binding proposal issued by the Dentist at Clinique Dentaire du Centre, Algiers, Algeria, and does not constitute a contractual obligation until formally accepted in writing by the client.
- Payment terms: A deposit of 40% (93,772.00 DZD) is required upon acceptance of this Quotation Estimate to schedule the first dental appointment. The remaining 60% balance shall be settled upon completion of all procedures.
- Accepted payment methods include bank transfer (CIB, BNA, or BNA), cash, and certified check. International card payments are not accepted at this Algiers, Algeria clinic.
- All dental procedures will be performed by the treating Dentist or a qualified associate dentist under direct supervision, in compliance with the Algerian Ministry of Health regulations and the National Order of Dentists (Ordre National des Chirurgiens-Dentistes d'Algérie).
- The client acknowledges that the final treatment plan may be adjusted by the Dentist based on intra-operative findings. Any additional procedures not listed in this Quotation Estimate will require prior written consent and a supplementary Quotation Estimate.
- Warranty: Ceramic crowns carry a 24-month warranty against manufacturing defects. Composite fillings carry a 12-month warranty. Warranty does not cover damage resulting from trauma, neglect, or non-compliance with post-operative care instructions.
- Confidentiality: All patient records, radiographic images, and clinical data are protected under Algerian data protection law and the professional secrecy obligations binding every registered Dentist in Algeria.
- This Quotation Estimate is governed by the laws of the People's Democratic Republic of Algeria. Any disputes arising from the interpretation or execution of this document shall be subject to the jurisdiction of the competent courts in Algiers, Algeria.
5. Acceptance and Authorization
By signing below, the client confirms that he has read, understood, and accepts the terms of this Quotation Estimate for dental services to be provided in Algiers, Algeria. The client authorizes the Dentist to proceed with the treatment plan as described herein.
For the Dentist / Clinic:
Dr. Amine Benali, D.D.S.Clinique Dentaire du Centre
Algiers, Algeria
Date: _______________
For the Client:
Mr. Karim HaddadSignature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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