Quotation Estimate Dentist in Colombia Bogotá –Free Word Template Download with AI
Clínica Dental Bogotá Premium
Carrera 15 # 93-45, Piso 4, Zona Rosa, Bogotá D.C., Colombia
Tel: +57 (601) 555 7842 | Email: [email protected]
NIT: 901.234.567-8 | Registrado en la Superintendencia de Industria y Comercio, Colombia
Prepared For (Client)
Name: María Alejandra Rodríguez Torres
Address: Calle 100 # 19A-32, Bogotá D.C., Colombia
Phone: +57 310 456 7890
Email: [email protected]
CC: 1.023.456.789 de Bogotá
Prepared By (Dentist)
Dentist: Dr. Carlos Andrés Mendoza, DDS
Specialty: General & Cosmetic Dentistry
License No.: 12345678 (Ministerio de Salud, Colombia)
Professional ID: R.M. 1.234.567
Years of Experience: 14 years in Bogotá
Quotation Estimate No.: QE-2025-04872 Date of Issue: June 15, 2025 Valid Until: July 15, 2025 (30 days) Currency: Colombian Peso (COP) Location: Bogotá D.C., Colombia Itemized Dental Services – Quotation Estimate Breakdown| No. | Dental Service Description | Procedure Code | Qty | Unit Price (COP) | Subtotal (COP) | |
|---|---|---|---|---|---|---|
| 1 | Comprehensive Oral Examination & Digital X-Rays (Panoramic + Periapical) | DDS-EX-001 | 1 | $185.000 | $185.000 | |
| 2 | Professional Dental Cleaning & Scaling (Ultrasonic + Manual) | DDS-CL-014 | 1 | $320.000 | $320.000 | |
| 3 | Composite Resin Filling – Tooth #14 (Upper Right First Molar) | DDS-FL-022 | 1 | $450.000 | $450.000 | |
| 4 | Root Canal Treatment – Tooth #21 (Upper Left Central Incisor), 3 visits | DDS-RC-031 | 1 | $1.250.000 | $1.250.000 | |
| 5 | Porcelain Crown (Zirconia) – Tooth #21, including temporary crown | DDS-CR-045 | 1 | $1.800.000 | $1.800.000 | |
| 6 | Teeth Whitening Treatment (In-Office, LED System) – 2 sessions | DDS-WH-058 | 2 | $650.000 | $1.300.000 | |
| 7 | Orthodontic Consultation & Digital Smile Design Assessment | DDS-OR-063 | 1 | $280.000 | $280.000 | |
| 8 | Follow-up Appointment & Post-Treatment Evaluation (includes 2 visits) | DDS-FU-071 | 2 | $120.000 | $240.000 | |
| 9 | Fluoride Varnish Application & Oral Hygiene Instruction | DDS-FV-082 | 1 | $95.000 | $95.000 | |
| 10 | Emergency Dental Kit (Take-home: pain relief, temporary filling material) | DDS-EM-090 | 1 | $85.000 | $85.000 | |
| TOTAL QUOTATION ESTIMATE (COP): | $6.055.000 | |||||
- All prices are quoted in Colombian Pesos (COP) and are inclusive of IVA (19% tax) as required by the DIAN – Dirección de Impuestos y Aduanas Nacionales, Colombia.
- This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, prices may be adjusted due to material cost fluctuations in the Bogotá dental supply market.
- The Dentist, Dr. Carlos Andrés Mendoza, guarantees all procedures performed at our Bogotá clinic in accordance with the standards set by the Ministerio de Salud y Protección Social of Colombia.
- Payment may be made in up to 3 installments: 40% upon acceptance of this Quotation Estimate, 40% upon completion of major procedures, and 20% at the final follow-up visit.
- Accepted payment methods: Bank transfer (Bancolombia, Davivienda, BBVA Colombia), credit/debit card (Visa, Mastercard, American Express), and cash at our Bogotá office.
- This Quotation Estimate does not constitute a binding contract. Final treatment plans may be adjusted after the comprehensive examination if additional dental needs are identified by the Dentist.
- Warranty: All restorative work (crowns, fillings, root canals) carries a 24-month warranty from the date of completion, provided the patient adheres to the post-treatment care instructions given by the Dentist.
- Our clinic in Bogotá D.C. operates Monday through Friday from 8:00 AM to 6:00 PM and Saturday from 8:00 AM to 1:00 PM. Emergency dental services are available 24/7 by phone.
- For patients with dental insurance (EPS: EPS, Sanitas, Sura, etc.), we can provide the necessary documentation for reimbursement claims. Please present your health card at the time of your first visit.
- This Quotation Estimate is prepared exclusively for the client named above and may not be transferred to a third party without written consent from Clínica Dental Bogotá Premium.
- The Dentist reserves the right to modify the treatment plan if clinical findings during the procedure differ from the initial assessment. Any additional costs will be communicated to the patient before proceeding.
- All personal health data collected during this process is protected under Ley 1581 de 2012 (Colombian Data Protection Law) and the regulations of the Superintendencia de Industria y Comercio.
- In the event of any dispute regarding this Quotation Estimate, both parties agree to first seek resolution through mediation in Bogotá D.C., Colombia, in accordance with Colombian consumer protection law (Ley 1480 de 2011).
- The patient acknowledges that dental procedures, while performed to the highest standard by the Dentist, may carry inherent risks. Informed consent will be obtained prior to any invasive procedure.
- This Quotation Estimate is issued in the city of Bogotá, Capital District, Colombia, and is governed by the civil and commercial laws of the Republic of Colombia.
Lead Dentist – Clínica Dental Bogotá Premium
License No. 12345678 – Ministerio de Salud, Colombia María Alejandra Rodríguez Torres
Client / Patient
CC: 1.023.456.789 de Bogotá ⬇️ Download as DOCX Edit online as DOCX
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