Quotation Estimate Dentist in Canada Vancouver –Free Word Template Download with AI
1284 West Georgia Street, Suite 450, Vancouver, British Columbia, V6E 1Y2, Canada
Phone: (604) 555-0198 | Email: [email protected]
BC College of Dentists License No. 48291 | Health Canada Registered Practice
Quotation EstimatePrepared For
Client Name: Mr. Jonathan R. MacLeod
Address: 742 Oakridge Avenue, Vancouver, BC, V6B 2K3, Canada
Phone: (604) 555-7742
Email: [email protected]
Quotation Details
Quotation No.: QTE-2025-04872
Date Issued: June 12, 2025
Valid Until: July 12, 2025
Prepared By: Dr. Sarah Chen, DDS, FICOI
Service Location: Vancouver, British Columbia, Canada
Dear Mr. MacLeod,
Thank you for choosing Vancouver Pacific Dental Clinic for your comprehensive dental care needs. This Quotation Estimate has been prepared following your initial consultation and diagnostic imaging session conducted on June 5, 2025, at our Vancouver, Canada office. The following document outlines the proposed treatment plan, itemized costs, and associated fees for the dental services recommended by our team of licensed Dentist professionals. All pricing reflects current 2025 Canadian dental fee schedules and is subject to the terms outlined below.
| # | Service / Procedure | Description | Qty | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination | Full oral assessment, periodontal charting, and digital radiographic imaging (panoramic and periapical X-rays) performed by a licensed Dentist in Vancouver, BC. | 1 | $285.00 | $285.00 |
| 2 | Professional Dental Cleaning (Prophylaxis) | Ultrasonic scaling, hand scaling, polishing, and fluoride varnish application. Includes intraoral photography for patient education. | 1 | $210.00 | $210.00 |
| 3 | Root Canal Treatment (Molar) | Endodontic therapy on tooth #30 (lower left first molar). Includes access cavity preparation, canal instrumentation, obturation, and temporary restoration. Performed by our endodontic specialist. | 1 | $1,450.00 | $1,450.00 |
| 4 | Ceramic Crown (Tooth #30) | Custom-fabricated all-ceramic (zirconia) crown to restore structural integrity following root canal therapy. Includes core build-up, impression taking, and final cementation. | 1 | $1,875.00 | $1,875.00 |
| 5 | Composite Fillings (Tooth #14, #24) | Two (2) medium-size tooth-coloured composite restorations for moderate caries. Includes local anaesthesia, isolation, and finishing/polishing. | 2 | $320.00 | $640.00 |
| 6 | Periodontal Deep Cleaning (Scaling & Root Planing) | Quadrant-specific deep cleaning for moderate periodontal disease (4mm+ pockets). Includes local anaesthesia, subgingival debridement, and post-operative instructions. | 4 | $385.00 | $1,540.00 |
| 7 | Full-Mouth Digital Intraoral Scan | 3D digital impression of all quadrants for treatment planning, crown design, and future prosthetic reference. No traditional impression material required. | 1 | $150.00 | $150.00 |
| 8 | Follow-Up Visit & Crown Adjustment | Post-operative check at 2 weeks and 6 weeks. Includes occlusal adjustment, bite verification, and periodontal re-evaluation. | 2 | $95.00 | $190.00 |
| Subtotal | $6,340.00 |
| BC GST (5%) | $317.00 |
| BC PST (7%) | $443.80 |
| Grand Total (CAD) | $7,100.80 |
Insurance Note: This Quotation Estimate is provided as a full-fee estimate. If you hold dental insurance coverage through a Canadian provider (e.g., Sun Life, Manulife, Canada Life, or a BC provincial plan), please submit this document to your insurer for pre-authorization. Our billing team in Vancouver will coordinate directly with your provider to determine your adjusted patient responsibility. The amounts listed above represent the Dentist's standard fee schedule and may differ from your plan's allowable amounts.
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After the validity period expires, fees may be adjusted to reflect changes in material costs, provincial fee schedules, or the Dentist's updated practice pricing in Vancouver, Canada.
- All dental procedures will be performed by a licensed Dentist or a registered dental specialist in good standing with the College of Dentists of British Columbia, in full compliance with Health Canada regulations and the BC Dental Practice Act.
- A deposit of 30% of the total estimated amount ($2,130.24 CAD) is required to confirm your appointment and secure treatment scheduling. The remaining balance is due upon completion of each phase of treatment.
- Payment may be made by Visa, Mastercard, Interac e-Transfer, or certified cheque. Our clinic in Vancouver accepts all major Canadian payment methods. Installment payment plans are available upon request for procedures exceeding $2,000 CAD.
- Should additional procedures become necessary during treatment that were not identified at the time of this Quotation Estimate, a revised estimate will be provided and your written consent will be obtained before any additional work commences.
- All work performed at our Vancouver, British Columbia clinic is covered by a one-year warranty on restorative work (crowns, fillings) and a two-year warranty on endodontic treatment, provided the patient maintains regular six-month recall visits.
- This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. The treating Dentist will exercise professional judgment during procedures and may modify the treatment approach based on intra-operative findings.
- By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined herein. This document is not a binding contract until the deposit is received and the treatment plan is formally accepted.
Lead Dentist, Vancouver Pacific Dental Clinic
Date: _______________ Client Acknowledgment
Mr. Jonathan R. MacLeod
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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