Quotation Estimate Dentist in Australia Melbourne –Free Word Template Download with AI
125 Collins Street, Melbourne, Victoria 3000, Australia
ABN: 48 123 456 789 | AHPRA Registration: 12345678901
Phone: (03) 9123 4567 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-00482
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Sarah Mitchell, Lead Dentist
Practice Location: Melbourne, Victoria, Australia
Client Information
Client Name: Mr. James Anderson
Address: 42 Albert Street, South Yarra, VIC 3141
Phone: 0412 345 678
Email: [email protected]
Health Fund: Bupa Dental (Gold Tier)
Member ID: BD-987654321
Dear Mr. Anderson,
Thank you for visiting our Melbourne dental practice for a comprehensive consultation and treatment planning session. As your treating Dentist, I have assessed your oral health requirements and prepared this detailed Quotation Estimate outlining the recommended course of treatment. This Quotation Estimate has been prepared in accordance with the Australian Dental Association (ADA) fee guidelines and reflects current market rates for dental services in Australia Melbourne metropolitan area.
Please review the itemised costs below carefully. All prices are quoted in Australian Dollars (AUD) and include applicable Goods and Services Tax (GST) at the current rate of 10%. Where applicable, estimated Health Fund rebates have been noted to assist you in understanding your out-of-pocket expenses.
| # | Dental Procedure / Service | Description | Qty | Unit Price (AUD) | Estimated Rebate (AUD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral examination, panoramic and periapical radiographs, periodontal charting | 1 | $285.00 | $120.00 |
| 2 | Ultrasonic Scaling and Polishing (Prophylaxis) | Full-mouth supragingival and subgingival scaling, fluoride varnish application | 1 | $245.00 | $110.00 |
| 3 | Composite Tooth-Coloured Restorations | Two-surface composite fillings on teeth #14 and #24 (premolars) | 2 | $320.00 | $140.00 |
| 4 | Root Canal Treatment (Endodontics) | Single-root canal treatment on tooth #36 (mandibular first molar), including temporary restoration | 1 | $1,150.00 | $450.00 |
| 5 | Porcelain Crown (Full-Ceramic) | Custom-fabricated zirconia crown for tooth #36, including core build-up and final cementation | 1 | $1,850.00 | $600.00 |
| 6 | Extraction of Tooth #48 (Wisdom Tooth) | Surgical extraction of impacted mandibular third molar under local anaesthesia, including post-operative instructions and follow-up | 1 | $680.00 | $280.00 |
| 7 | Professional Teeth Whitening (In-Office) | Single-visit LED-activated whitening treatment using hydrogen peroxide gel (35%) | 1 | $495.00 | $0.00 |
| 8 | Follow-Up Review and Suture Removal | Post-extraction review at 7 days, suture removal, healing assessment | 1 | $95.00 | $40.00 |
| TOTAL ESTIMATED COST (Incl. 10% GST) | $5,520.00 | $1,840.00 | |||
| ESTIMATED OUT-OF-POCKET (After Rebate) | $3,680.00 | ||||
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision in line with current Australian dental fee schedules.
- All fees are quoted in Australian Dollars (AUD) and include Goods and Services Tax (GST) at the prevailing rate. No additional charges will be applied beyond those itemised in this Quotation Estimate without prior written consent from the client.
- Payment is due at the time of each appointment. We accept all major credit cards (Visa, Mastercard, Amex), EFTPOS, and bank transfer. A 50% deposit is required to secure appointment times for procedures exceeding $500.00.
- Estimated Health Fund rebates are based on the current Bupa Dental Gold Tier benefit schedule as of June 2025. Actual rebates may vary depending on your annual benefit limits, waiting periods, and any changes to your policy. We recommend confirming your remaining benefits directly with your health insurer before commencing treatment.
- As your treating Dentist, I am committed to providing the highest standard of care in accordance with the Australian Dental Association's National Clinical Guidelines. All procedures will be performed in a sterile, accredited environment compliant with Victorian health and safety regulations.
- Should you wish to cancel or reschedule an appointment, please provide a minimum of 48 hours' notice. Late cancellations or no-shows may incur a fee of $100.00 to cover the reserved clinical time.
- This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. Dental treatment, particularly endodontic and surgical procedures, carries inherent risks which will be discussed with you in detail during your pre-treatment consultation.
- All patient records, radiographs, and treatment plans are maintained in strict compliance with the Australian Privacy Act 1988 and the National Privacy Principles.
- For any queries regarding this Quotation Estimate, please contact our Melbourne practice office during business hours (Monday to Friday, 8:00 AM – 5:30 PM) or email our administrative team.
Lead Dentist, Melbourne Dental Care Centre
AHPRA Reg. No: 12345678901 Client Acknowledgement
Mr. James Anderson
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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