Quotation Estimate Dentist in China Guangzhou –Free Word Template Download with AI
128 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China 510620
Tel: +86-20-8888-6666 | Email: [email protected]
License No.: GZ-DENT-2024-00387 | NMPA Registered
Quotation EstimateQuotation Details
Quotation No.: QTE-GZ-2025-04127
Date Issued: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Currency: Chinese Yuan (CNY / RMB)
Prepared By: Dr. Liang Wei, Lead Dentist
Client Information
Name: Mr. / Ms. [Client Name]
Address: [Client Address], Guangzhou, China
Contact: [Phone Number]
Email: [Email Address]
Referral Source: Walk-in / Insurance Partner
This Quotation Estimate has been prepared by our qualified Dentist team at Guangzhou Pearl River Dental Clinic, located in the heart of China Guangzhou, to provide a comprehensive and transparent breakdown of the proposed dental treatment plan. All pricing reflects current rates as of the date of issue and is subject to the terms outlined below. This document serves as a formal Quotation Estimate for the patient's review and approval prior to any clinical procedures being performed.
Itemized Treatment Plan & Pricing| No. | Procedure / Service | Description | Qty | Unit Price (CNY) |
|---|---|---|---|---|
| 1 | Comprehensive Dental Examination | Full oral assessment by the lead Dentist, including intraoral photography, periodontal charting, and digital panoramic X-ray (OPG) to establish a baseline diagnosis in our China Guangzhou facility. | 1 | ¥ 380.00 |
| 2 | Professional Dental Cleaning (Scaling & Polishing) | Ultrasonic scaling above and below the gumline, followed by air-polishing and fluoride varnish application. Performed by a certified dental hygienist under Dentist supervision. | 1 | ¥ 520.00 |
| 3 | Composite Resin Filling (Posterior Tooth) | Removal of carious tissue and restoration with 3M Z350 XT composite resin material. Includes local anesthesia and post-operative instructions. Standard procedure at our Guangzhou clinic. | 2 | ¥ 680.00 |
| 4 | Root Canal Treatment (Single-Root Molar) | Complete endodontic therapy including access cavity preparation, canal instrumentation, obturation with gutta-percha, and temporary restoration. Performed by a specialist Dentist with over 12 years of experience in China Guangzhou. | 1 | ¥ 2,800.00 |
| 5 | Porcelain Crown (Zirconia) | Fabrication and cementation of a full-coverage zirconia crown using CAD/CAM technology. Includes digital impression, try-in appointment, and final seating. Manufactured by a certified laboratory in Guangzhou, Guangdong. | 1 | ¥ 3,500.00 |
| 6 | Wisdom Tooth Extraction (Lower, Impacted) | Surgical removal of a partially impacted mandibular third molar under local anesthesia with sedation option. Includes pre-operative CBCT scan, post-operative medication, and one follow-up visit at our China Guangzhou office. | 1 | ¥ 1,800.00 |
| 7 | Follow-Up Consultation & Post-Operative Review | Two follow-up appointments (at 1 week and 4 weeks) with the treating Dentist to monitor healing, adjust occlusion, and provide aftercare guidance. | 2 | ¥ 150.00 |
| 8 | Local Anesthesia & Sedation (if applicable) | Supplemental nitrous oxide sedation for anxious patients during the extraction procedure. Administered by a trained anesthetic nurse under Dentist oversight. | 1 | ¥ 350.00 |
| Cost Summary | |||
|---|---|---|---|
| Subtotal: | ¥ 11,610.00 | ||
| VAT (6% – Medical Services, PRC): | ¥ 696.60 | ||
| Total Quotation Estimate Amount: | ¥ 12,306.60 | ||
1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to revision upon expiration due to changes in material costs, regulatory adjustments in China Guangzhou, or exchange rate fluctuations.
2. Payment Schedule: A 50% deposit (CNY 6,153.30) is required to confirm the appointment and reserve the Dentist's schedule. The remaining 50% balance is due upon completion of the final procedure. Payment may be made via WeChat Pay, Alipay, bank transfer, or major credit cards accepted at our Guangzhou clinic.
3. Cancellation Policy: Appointments cancelled with less than 48 hours' notice will incur a 20% fee of the scheduled procedure cost. The initial deposit is non-refundable once the treatment plan has been initiated.
4. Scope of Work: This Quotation Estimate covers only the procedures listed above. Any additional treatments identified during the clinical examination (e.g., unexpected additional fillings, additional extractions, or periodontal therapy) will be discussed with the patient and a supplementary Quotation Estimate will be issued before any further work commences.
5. Warranties: All restorative work (crowns, fillings) carries a 24-month warranty against material defects under normal use. Root canal treatments carry a 12-month warranty. Warranty claims must be presented to the treating Dentist at our China Guangzhou location.
6. Regulatory Compliance: All procedures are performed in accordance with the National Medical Products Administration (NMPA) regulations of the People's Republic of China. The treating Dentist holds a valid Practicing Certificate issued by the Guangzhou Municipal Health Commission.
7. Insurance: This Quotation Estimate may be submitted to the patient's commercial health insurance provider or the Guangzhou Municipal Basic Medical Insurance Bureau for partial reimbursement, subject to the policy's coverage terms. Our clinic provides itemized receipts for insurance claims.
8. Confidentiality: All patient records, radiographs, and clinical notes are maintained in strict accordance with the Personal Information Protection Law (PIPL) of the People's Republic of China. No data will be shared without written patient consent.
Acceptance & AuthorizationBy signing below, the patient acknowledges that they have read and understood this Quotation Estimate, confirms that the proposed treatment plan has been explained by the Dentist in understandable terms, and authorizes the commencement of the listed procedures at Guangzhou Pearl River Dental Clinic, China Guangzhou.
Patient Signature & Date Dentist (Dr. Liang Wei) – Signature & Date Clinic Administrator – Stamp & Date ⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
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