Quotation Estimate Dentist in Chile Santiago –Free Word Template Download with AI
Av. Providencia 1234, Of. 501, Providencia, Santiago, Chile
Phone: +56 2 2345 6789 | Email: [email protected]
RUT: 76.543.210-K | Registro de Salud: 4521-2019
Quotation Estimate Official Document
Quotation Details
Quotation No.: QE-2025-04871
Date Issued: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Currency: Chilean Peso (CLP)
Client Information
Name: [Client Full Name]
RUT: [XX.XXX.XXX-X]
Address: [Street, Commune], Santiago, Chile
Phone: +56 9 [XXXX XXXX]
Email: [[email protected]]
The following Quotation Estimate outlines the comprehensive dental treatment plan prepared by our licensed Dentist team at Clínica Dental Santiago Centro, located in the heart of Santiago, Chile. All prices are expressed in Chilean Pesos (CLP) and include applicable IVA (19% VAT) as mandated by the Servicio de Impuestos Nacionales of Chile.
| # | Dental Service / Procedure | Description | Qty | Unit Price (CLP) | Subtotal (CLP) | |
|---|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Diagnostic X-Rays | Full intraoral exam, panoramic radiograph, and periodontal assessment by the attending Dentist | 1 | $35.000 | $35.000 | |
| 2 | Professional Dental Cleaning (Prophylaxis) | Ultrasonic scaling, air polishing, and fluoride varnish application | 1 | $48.000 | $48.000 | |
| 3 | Composite Resin Filling (Posterior Tooth) | Two-surface composite restoration on molar #36, including local anesthesia | 2 | $65.000 | $130.000 | |
| 4 | Root Canal Treatment (Endodontics) | Single-canal root canal on premolar #24 with gutta-percha obturation and temporary restoration | 1 | $185.000 | $185.000 | |
| 5 | Ceramic Crown (Zirconia) | Full zirconia crown for tooth #24, including digital impression and temporary crown | 1 | $320.000 | $320.000 | |
| 6 | Orthodontic Consultation & Treatment Plan | Initial orthodontic evaluation, study models, and digital treatment simulation by the orthodontic Dentist | 1 | $55.000 | $55.000 | |
| 7 | Periodontal Deep Cleaning (Scaling & Root Planing) | Quadrant-specific deep cleaning for moderate periodontitis, including local anesthetic | 2 | $95.000 | $190.000 | |
| 8 | Follow-Up Visit & Post-Operative Check | Two follow-up appointments at 2 weeks and 6 weeks for healing assessment | 2 | $20.000 | $40.000 |
Subtotal (before IVA): CLP $1.003.000
IVA (19%): CLP $190.570
Grand Total: CLP $1.193.570
* All prices in this Quotation Estimate are inclusive of IVA. Payment in Chilean Pesos (CLP) only. Foreign currency transactions subject to exchange rate on the day of payment.
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 adjusted to reflect current market rates for dental materials and professional fees in Santiago, Chile.
- All dental procedures listed in this Quotation Estimate will be performed by a licensed Dentist registered with the Colegio de Cirujanos Dentistas de Chile and the Superintendencia de Salud.
- Payment may be made in full upon acceptance of this Quotation Estimate, or in up to three (3) equal monthly installments without interest. A 10% discount applies to full upfront payment.
- Accepted payment methods include: bank transfer (transferencia bancaria), credit/debit card (Visa, Mastercard, American Express), and cash at our Santiago office. A formal invoice (factura) will be issued upon each payment.
- Rescheduling of appointments must be communicated at least 48 hours in advance. Cancellations within 24 hours of the scheduled appointment may incur a fee of CLP $15.000.
- Warranty: All restorative work (crowns, fillings) carries a 12-month warranty against material defects. Root canal treatments carry an 18-month warranty. Warranty does not cover damage caused by trauma, neglect, or non-compliance with post-operative instructions.
- This Quotation Estimate does not constitute a medical diagnosis. Final treatment plans may be adjusted by the attending Dentist after the initial in-person examination at our Santiago, Chile clinic.
- Client data is processed in accordance with Chilean Law 19.628 on the Protection of Private Life and the General Data Protection regulations. Information is stored securely and will not be shared with third parties without explicit consent.
- Our clinic operates Monday through Friday from 09:00 to 19:00 and Saturday from 09:00 to 14:00. Emergency dental services are available by prior phone appointment.
Dr. Carolina Reyes M.
Lead Dentist – Clínica Dental Santiago Centro
RUT: 12.345.678-9 | Cédula Profesional: CD-4521 Accepted by (Client):
[Client Full Name]
RUT: [XX.XXX.XXX-X]
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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