Quotation Estimate Dentist in Brazil Brasília –Free Word Template Download with AI
Professional Dental Services — Brasília, Distrito Federal, Brazil
Dentist — CRO-DF 12.345 Practice Name: Clínica Odontológica Brasília PrimeAddress: SHIS QI 05, Bloco A, Sala 12, Lago Sul
City: Brasília — DF — 71610-340, Brazil
Phone: +55 (61) 3321-4567
Email: [email protected] Quotation No.: QTE-2025-00847
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Ricardo Almeida, DDS
| Full Name: Maria Helena Santos Oliveira | CNPJ / CPF: 123.456.789-00 |
| Address: CLS 308, Bloco B, Apt 42, Asa Sul | City: Brasília — DF — 70373-520, Brazil |
| Phone: +55 (61) 99876-5432 | Email: [email protected] |
This Quotation Estimate has been prepared by our qualified Dentist team at Clínica Odontológica Brasília Prime, located in the heart of Brasília, Distrito Federal, Brazil. Following a comprehensive clinical evaluation and diagnostic imaging performed on 10 June 2025, the following dental treatment plan and cost estimate are hereby presented for the client's review and approval. All prices are quoted in Brazilian Reais (BRL) and include applicable taxes as per the tax regulations of the Federal District of Brazil.
| Item | Description of Dental Service | Qty | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|
| 01 | Complete Oral Examination & Digital Panoramic X-Ray (CBCT 3D Imaging) | 1 | R$ 480,00 | R$ 480,00 |
| 02 | Professional Dental Cleaning & Polishing (Prophylaxis) — Upper and Lower Arch | 1 | R$ 350,00 | R$ 350,00 |
| 03 | Endodontic Treatment (Root Canal Therapy) — Molar, Upper Right (Tooth #16) | 1 | R$ 2.800,00 | R$ 2.800,00 |
| 04 | Composite Resin Restoration — Occlusal Surface, Lower Left Molar (Tooth #36) | 2 | R$ 520,00 | R$ 1.040,00 |
| 05 | Porcelain Crown (Zirconia) — Upper Right Molar (Tooth #16), Post-Endodontic | 1 | R$ 3.200,00 | R$ 3.200,00 |
| 06 | Periodontal Scaling & Root Planing — Full Mouth (4 Quadrants) | 1 | R$ 1.600,00 | R$ 1.600,00 |
| 07 | Extraction of Impacted Wisdom Tooth — Lower Left (Tooth #38), Surgical | 1 | R$ 1.450,00 | R$ 1.450,00 |
| 08 | Follow-Up Consultations & Post-Operative Care (3 Sessions) | 3 | R$ 180,00 | R$ 540,00 |
| 09 | Prescription Medications & Post-Operative Kit (Antibiotics, Analgesics, Mouthwash) | 1 | R$ 220,00 | R$ 220,00 |
| TOTAL ESTIMATED COST (BRL) | R$ 11.680,00 | |||
- Payment Schedule: The total amount of R$ 11.680,00 may be settled in up to 6 (six) equal monthly installments of R$ 1.946,67 via bank transfer (TED/PIX) or credit card, with the first installment due upon acceptance of this Quotation Estimate.
- PIX Payment: A 5% discount (R$ 584,00) is available for full payment via PIX, reducing the total to R$ 11.096,00.
- Health Insurance (Plano de Saúde): The client is advised to verify coverage with their dental insurance provider (e.g., Amil Dental, OdontoPrev, Bradesco Dental) prior to scheduling. Our practice in Brasília accepts most major plans registered with ANS (Agência Nacional de Saúde Suplementar).
- Validity: This Quotation Estimate is valid for 30 (thirty) calendar days from the date of issue. After this period, prices may be adjusted to reflect current market rates in Brasília, DF.
- Cancellation: In the event the client cancels scheduled appointments with less than 48 hours' notice, a fee of R$ 200,00 per missed session will be applied.
- Warranty: All restorative and prosthetic work is covered by a 24-month warranty, provided the client adheres to the recommended maintenance schedule and attends all follow-up appointments at our Brasília clinic.
This Quotation Estimate is issued by Dr. Ricardo Almeida, DDS, a licensed Dentist registered with the Conselho Regional de Odontologia do Distrito Federal (CRO-DF) under number 12.345. The practice operates in full compliance with the Brazilian Health Regulatory Agency (ANVISA) and the Federal Council of Dentistry (CFO) guidelines. All dental materials and equipment used at our Brasília facility meet the quality and safety standards mandated by Brazilian federal and district legislation.
Dr. Ricardo Almeida, DDSTreating Dentist — CRO-DF 12.345
Clínica Odontológica Brasília Prime Client Acknowledgment
Maria Helena Santos Oliveira
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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