Quotation Estimate Dentist in Brazil São Paulo –Free Word Template Download with AI

This Quotation Estimate has been prepared by our team of licensed Dentist professionals at Clínica Odontológica Paulista Premium, located in the heart of São Paulo, Brazil. The following itemized breakdown reflects the comprehensive dental treatment plan recommended after the initial clinical evaluation performed on 10 June 2025. All prices are quoted in Brazilian Reais (BRL) and include applicable taxes as per São Paulo state regulations.

• Payment Schedule: This Quotation Estimate may be settled in up to 6 (six) equal monthly installments of R$ 1.897,00 via bank transfer (TED/PIX) to the account of Clínica Odontológica Paulista Premium, Banco do Brasil, Ag. 1234-5, CC 98765-4. No interest is applied for installments within 6 months.
• Down Payment: A non-refundable deposit of 20% (R$ 2.276,40) is required to schedule the first treatment session. The remaining balance shall be paid in equal monthly installments as described above.
• PIX Payment: The client may opt for a single PIX payment to the key [email protected] and receive a 5% discount, reducing the total to R$ 10.812,90.
• Health Insurance (Plano de Saúde): If the client holds a dental plan (e.g., OdontoPrev, Amil Dental, Bradesco Dental) registered in São Paulo, Brazil, a portion of the services listed in items 01, 02, 06, and 08 may be covered. The client is responsible for presenting the insurance card at the time of the appointment. The Dentist will submit the claim directly to the insurer where applicable.
• Validity: This Quotation Estimate is valid for 30 (thirty) calendar days from the date of issue. Prices are subject to revision based on the current São Paulo Consumer Protection Code (Código de Defesa do Consumidor — Lei 8.078/1990) and any changes in material costs.
• Warranty: All restorative and prosthetic dental procedures performed by our Dentist team carry a minimum 12-month warranty, in compliance with Brazilian consumer law. The warranty does not cover damage caused by trauma, neglect, or failure to attend scheduled follow-up appointments.
• Cancellation: In the event the client cancels the treatment plan after the down payment has been made, the deposit will be forfeited. Cancellations prior to the down payment incur no charges.
• Regulatory Compliance: All dental procedures are performed in strict accordance with the regulations of the Conselho Regional de Odontologia de São Paulo (CRO-SP) and the Brazilian Health Regulatory Agency (ANVISA). Our facility is registered under CRO-SP and holds all necessary sanitary permits for the city of São Paulo.

This Quotation Estimate is a good-faith projection of costs based on the clinical findings at the time of the initial consultation. Should the Dentist identify additional pathologies or complications during the course of treatment (e.g., additional root canals, unexpected bone loss requiring periodontal surgery, or the need for extractions), a supplementary Quotation Estimate will be issued and presented to the client for written approval before any additional procedures are performed. No extra work will be carried out without the client's explicit consent.

The client acknowledges that this document constitutes a formal Quotation Estimate for dental services and does not represent a binding contract until the down payment is received and a signed treatment agreement is executed at our São Paulo, Brazil clinic. By accepting this Quotation Estimate, the client agrees to the terms outlined above and to the general privacy policy of Clínica Odontológica Paulista Premium, in compliance with the Brazilian General Data Protection Law (LGPD — Lei 13.709/2018).