Quotation Estimate Dentist in Australia Brisbane –Free Word Template Download with AI
142 Creek Street, Fortitude Valley, Brisbane, Queensland 4006, Australia
ABN: 48 215 673 901 | AHPRA Registration: 1234567
Phone: (07) 3856 4200 | Email: [email protected]
Quotation EstimatePrepared For
Mr. James A. Whitfield
78 Anzac Avenue, New Farm
Brisbane, Queensland 4005, Australia
Phone: 0412 338 761
Email: [email protected]
Quotation Details
Quotation No.: QTE-2025-04872
Date Issued: 12 June 2025
Valid Until: 12 July 2025 (30 days)
Prepared By: Dr. Sarah Chen, Lead Dentist
Practice Location: Australia Brisbane
Dear Mr. Whitfield,
Thank you for visiting our practice in Australia Brisbane for a comprehensive dental consultation on 5 June 2025. Following your examination, this Quotation Estimate has been prepared by our Lead Dentist, Dr. Sarah Chen, to outline the recommended treatment plan and associated costs. This Quotation Estimate reflects the current fee schedule of Brisbane Riverside Dental Clinic and is provided in accordance with the Australian Dental Association (ADA) fee guidelines applicable to practices operating in Australia Brisbane.
| Ref | Dental Procedure / Service | Description | Qty | Unit Price (AUD) | Subtotal (AUD) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination | Full intraoral examination, digital panoramic X-ray (OPG), and periodontal charting conducted by the treating Dentist. | 1 | $185.00 | $185.00 |
| 02 | Professional Dental Hygiene & Scaling | Ultrasonic scaling, hand scaling, and polishing of all accessible teeth. Performed by a registered Dental Hygienist under Dentist supervision. | 1 | $245.00 | $245.00 |
| 03 | Composite Tooth-Coloured Filling (Upper Right Molar #16) | Removal of carious decay and restoration with nano-hybrid composite resin. Includes local anaesthesia and post-operative review. | 1 | $320.00 | $320.00 |
| 04 | Composite Tooth-Coloured Filling (Lower Left Premolar #34) | Removal of carious decay and restoration with nano-hybrid composite resin. Includes local anaesthesia. | 1 | $295.00 | $295.00 |
| 05 | Root Canal Treatment (Lower Left Molar #36) | Endodontic treatment including access cavity preparation, canal debridement, obturation, and temporary restoration. Performed by the treating Dentist over two appointments. | 1 | $1,150.00 | $1,150.00 |
| 06 | Porcelain Crown (Lower Left Molar #36) | Full ceramic (zirconia) crown to restore structural integrity following root canal treatment. Includes impression, temporary crown, and final cementation. | 1 | $1,480.00 | $1,480.00 |
| 07 | Periapical X-Rays (4 views) | Targeted digital radiographs of affected teeth for diagnostic purposes, as recommended by the treating Dentist. | 4 | $38.00 | $152.00 |
| 08 | Post-Operative Review & Adjustment | Follow-up appointment at 2 weeks to assess healing, occlusion, and patient comfort. Conducted by the treating Dentist. | 1 | $95.00 | $95.00 |
| 09 | Fluoride Varnish Application | Topical fluoride varnish applied to all teeth to strengthen enamel and reduce future caries risk. | 1 | $65.00 | $65.00 |
| Quotation Estimate Summary | |||
|---|---|---|---|
| Subtotal (AUD) | $3,887.00 | ||
| GST (10%) | $388.70 | ||
| Total Quotation Estimate (AUD, incl. GST) | $4,275.70 | ||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, fees may be subject to revision in line with the current Australian Dental Association fee schedule for Australia Brisbane.
- Payment is due in full at the time of each treatment appointment unless a written payment plan has been arranged in advance with the practice manager. Accepted payment methods include EFTPOS, bank transfer, and major credit/debit cards.
- A 20% deposit is required to secure the first treatment appointment for procedures exceeding $500.00 AUD, as is standard practice for dental clinics in Australia Brisbane.
- Should the patient wish to cancel an appointment, a minimum of 48 hours' notice is required. Late cancellations or no-shows may incur a fee of $85.00 AUD to cover the Dentist's reserved time.
- All clinical procedures will be performed by a registered Dentist or Dental Therapist holding current AHPRA registration, in full compliance with the Queensland Health regulations governing dental practices in Australia Brisbane.
- This Quotation Estimate does not constitute a guarantee of outcome. The treating Dentist will exercise all reasonable clinical judgement during treatment. In the event of unforeseen complications, the patient will be informed and consented to any deviation from the original plan.
- Warranty: All restorative work (fillings, crowns) carries a 12-month warranty against material defects under normal use. This warranty does not cover damage from trauma, bruxism, or failure to attend scheduled recall appointments.
- Health insurance: This Quotation Estimate reflects private (out-of-pocket) fees. If the patient holds a private health insurance policy with dental cover, the practice will submit a claim on the patient's behalf. The patient is responsible for any gap between the insurer's rebate and the fees quoted herein.
- This Quotation Estimate is prepared in accordance with the Australian Consumer Law and the Privacy Act 1988 (Cth). All patient records and clinical data are stored securely in compliance with Australian privacy legislation.
By signing below, the patient acknowledges that they have received, read, and understood this Quotation Estimate. The patient consents to the proposed treatment plan as outlined by the treating Dentist at Brisbane Riverside Dental Clinic, Australia Brisbane, and agrees to the terms and conditions set out above.
|
Patient Signature: Name: James A. Whitfield Date: ____________________ |
Dentist / Authorising Practitioner: Name: Dr. Sarah Chen, BDS, MDS (Endo) AHPRA Reg. No: 1234567 Date: 12 June 2025 |
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