Quotation Estimate Dentist in Brazil Rio de Janeiro –Free Word Template Download with AI
Professional Dental Services — Rio de Janeiro, Brazil
Official Quotation Estimate Document Clínica Odontológica Rio SorrisoAv. Atlântica, 2500 — Copacabana
Rio de Janeiro, RJ — CEP 22070-001
Brazil
Tel: +55 (21) 3456-7890
Email: [email protected]
CNPJ: 12.345.678/0001-90 Quotation Estimate No.: QE-2025-04872
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Currency: BRL (Brazilian Real) Prepared For: Mr. Carlos Eduardo Santos CPF: 123.456.789-00 Address: Rua das Laranjeiras, 145 — Rio de Janeiro, RJ
This Quotation Estimate has been prepared by Clínica Odontológica Rio Sorriso, a licensed and accredited Dentist practice operating in the heart of Rio de Janeiro, Brazil, to provide Mr. Carlos Eduardo Santos with a comprehensive and transparent breakdown of the estimated costs associated with a full course of dental treatment. As a Dentist firm committed to excellence in the Rio de Janeiro metropolitan area, we understand that financial planning is essential for our patients. This Quotation Estimate serves as a formal, non-binding financial projection of the services to be rendered, allowing the client to make an informed decision regarding his dental care in Brazil.
Following a thorough clinical examination conducted on 10 June 2025 at our Rio de Janeiro, Brazil facility, our lead Dentist, Dr. Mariana Oliveira (CRO-RJ 45.678), has recommended the following comprehensive treatment plan. Each procedure listed below reflects the standard of care expected from a top-tier Dentist practice in Rio de Janeiro and has been priced in accordance with the current fee schedule of the Regional Council of Dentistry of Rio de Janeiro (CRO-RJ).
| Ref. | Dental Procedure | Description | Qty | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|---|
| 01 | Comprehensive Oral Examination & Digital X-Rays | Full intraoral assessment, panoramic radiograph, and periapical X-rays (4 views) | 1 | R$ 480,00 | R$ 480,00 |
| 02 | Professional Dental Cleaning (Prophylaxis) | Ultrasonic scaling, air-polishing, and fluoride varnish application | 1 | R$ 350,00 | R$ 350,00 |
| 03 | Composite Resin Restorations (Anterior Teeth) | Multi-surface composite fillings on teeth #11 and #21 | 2 | R$ 620,00 | R$ 1.240,00 |
| 04 | Root Canal Treatment (Endodontics) | Single-canal root canal on tooth #36 with gutta-percha obturation | 1 | R$ 1.850,00 | R$ 1.850,00 |
| 05 | Ceramic Crown (Zirconia) | Full zirconia crown on tooth #36, including temporary crown and final cementation | 1 | R$ 2.400,00 | R$ 2.400,00 |
| 06 | Wisdom Tooth Extraction (Lower Left) | Surgical extraction of tooth #38 with sutures and post-operative care | 1 | R$ 1.200,00 | R$ 1.200,00 |
| 07 | Orthodontic Consultation & Alignment Plan | Initial orthodontic evaluation, digital scan, and treatment planning by our Dentist specialist | 1 | R$ 550,00 | R$ 550,00 |
| 08 | Follow-Up Visits (Post-Operative) | Three scheduled follow-up appointments for healing assessment and adjustments | 3 | R$ 180,00 | R$ 540,00 |
| TOTAL ESTIMATED COST | R$ 8.610,00 | ||||
This Quotation Estimate from our Dentist practice in Rio de Janeiro, Brazil, is valid for thirty (30) calendar days from the date of issue. The total estimated amount of R$ 8.610,00 (eight thousand six hundred and ten Brazilian Reais) may be settled under any of the following payment arrangements:
- Full Payment: 100% at the time of service initiation, with a 5% discount applied, reducing the total to R$ 8.179,50.
- Installment Plan: 30% upfront (R$ 2.583,00) followed by 5 monthly installments of R$ 1.205,40 each, payable via bank transfer or credit card.
- Insurance / Convênio: If the client holds a dental plan (e.g., Amil Dental, OdontoPrev, Bradesco Dental), the applicable coverage will be deducted, and the client will be responsible only for the co-payment portion as defined by the plan terms.
- This Quotation Estimate is a good-faith projection based on the clinical findings at the time of examination. The final cost may vary if additional procedures are identified during treatment.
- All prices are quoted in Brazilian Reais (BRL) and are inclusive of applicable taxes as per Brazilian federal and state regulations in Rio de Janeiro.
- Materials such as zirconia crowns, composite resins, and orthodontic appliances are sourced from certified suppliers and carry manufacturer warranties.
- This Quotation Estimate does not constitute a binding contract. A formal service agreement will be signed prior to the commencement of any dental procedure.
- Our Dentist team in Rio de Janeiro, Brazil, adheres to all ethical and professional standards set forth by the Conselho Federal de Odontologia (CFO) and the Regional Council of Rio de Janeiro (CRO-RJ).
- Emergency or after-hours appointments may incur additional fees not included in this Quotation Estimate.
By signing below, the client acknowledges receipt of this Quotation Estimate for dental services provided by Clínica Odontológica Rio Sorriso, a Dentist practice in Rio de Janeiro, Brazil. The client confirms that the scope of work, estimated costs, and payment terms have been reviewed and understood. This signature does not obligate the client to proceed with treatment but serves as confirmation that the Quotation Estimate has been delivered and explained.
Client SignatureMr. Carlos Eduardo Santos
Date: _______________ Dentist / Authorized Representative
Dr. Mariana Oliveira, CRO-RJ 45.678
Clínica Odontológica Rio Sorriso
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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