Quotation Estimate Dentist in Egypt Alexandria –Free Word Template Download with AI

Quotation No.: QTE-2025-0417 Date of Issue: 15 June 2025 Valid Until: 15 July 2025 Currency: Egyptian Pound (EGP) Client & Referral Information

Prepared For (Patient)

Name: Mr. Ahmed Hassan El-Sayed

Address: 45 Mansheya Street, Dokki, Giza, Egypt

Phone: +20 100 555 7890

National ID: 28905120101234

Prepared By (Dentist)

Dentist: Dr. Mona Fathy Abdel-Rahman

Specialty: Prosthodontics & Restorative Dentistry

Registration: Alexandria Medical Syndicate No. 4521

Clinic Location: Smouha, Alexandria, Egypt

Quotation Estimate – Itemized Dental Treatment Plan

This Quotation Estimate has been prepared by our Dentist team at the Alexandria Coastal Dental Clinic following a comprehensive clinical examination and diagnostic imaging (panoramic X-ray and intraoral photographs) conducted on 12 June 2025. The following treatment plan outlines all recommended Dentist procedures to be performed at our facility in Egypt Alexandria. All prices are inclusive of materials, anesthesia, and standard follow-up visits within the treatment period.

No.	Dental Procedure / Service	Description	Qty	Unit Price (EGP)	Total (EGP)
1	Full Oral Examination & Diagnostic Imaging	Panoramic X-ray, 4 intraoral periapical radiographs, clinical assessment	1	850	850
2	Ultrasonic Scaling & Polishing (Full Mouth)	Removal of supragingival and subgingival calculus, professional polishing	1	1,200	1,200
3	Composite Resin Fillings (Posterior Teeth)	Class II composite restoration, tooth #14 and #24	2	1,800	3,600
4	Root Canal Treatment (Single-Root Molar)	Tooth #36, including gutta-percha obturation and temporary crown	1	4,500	4,500
5	Full-Ceramic Crown (Zirconia)	Tooth #36, CAD/CAM milled zirconia crown, 2 visits	1	6,500	6,500
6	Extraction of Impacted Wisdom Tooth	Tooth #48, surgical extraction under local anesthesia, sutures	1	3,200	3,200
7	Periodontal Deep Cleaning (Scaling & Root Planing)	Quadrant 3 and 4, subgingival debridement	2	1,500	3,000
8	Fluoride Varnish Application	Full-arch protective fluoride treatment	1	400	400
9	Follow-Up Visits (Post-Treatment Review)	Two scheduled check-ups at 2 weeks and 6 weeks	2	350	700
10	Prescription Medications & Post-Operative Kit	Antibiotics, analgesics, chlorhexidine mouthwash, soft toothbrush	1	650	650
GRAND TOTAL (EGP)					24,600

Note: This Quotation Estimate is valid for 30 days from the date of issue. Prices are subject to change based on material availability and exchange rate fluctuations affecting imported dental products in Egypt. A 20% deposit is required to reserve the treatment schedule at our Alexandria clinic. The remaining balance is due upon completion of each major procedure. Terms & Conditions of This Quotation Estimate

This Quotation Estimate is a non-binding document issued by the Alexandria Coastal Dental Clinic, a licensed Dentist practice operating in Alexandria, Egypt, under the supervision of the Alexandria Health Directorate.
All dental procedures listed above will be performed by Dr. Mona Fathy Abdel-Rahman or a qualified assistant Dentist under her direct supervision at our clinic located in Smouha, Alexandria, Egypt.
The patient consents to the treatment plan outlined in this Quotation Estimate and acknowledges that the Dentist has explained all risks, alternatives, and expected outcomes in both Arabic and English.
Payment may be made in Egyptian Pounds (EGP) via cash, bank transfer to the clinic's account at CIB Alexandria Branch, or through approved credit/debit cards. No foreign currency transactions are accepted.
A 20% non-refundable deposit (EGP 4,920) secures the patient's appointment slots. The balance of EGP 19,680 shall be paid in two installments: 50% after the root canal and crown procedures, and 50% upon completion of the extraction and periodontal work.
Warranty: All ceramic crowns carry a 2-year warranty against manufacturing defects. Composite fillings carry a 1-year warranty. Root canal treatments carry a 2-year warranty against re-infection, provided the patient attends all scheduled follow-up visits at our Alexandria clinic.
In the event of emergency complications requiring additional intervention not listed in this Quotation Estimate, the Dentist will notify the patient in writing and issue a supplementary estimate before proceeding with any additional work.
This Quotation Estimate does not constitute a medical guarantee. The Dentist in Alexandria, Egypt, will use reasonable professional judgment and best clinical practices in accordance with the Egyptian Medical Syndicate's code of conduct.
Confidentiality: All patient records, radiographs, and treatment details are protected under Egyptian Law No. 19 of 2018 regarding the protection of personal data. No information will be shared without the patient's written consent.
Disputes arising from this Quotation Estimate shall be resolved through the Alexandria Medical Syndicate's dispute resolution committee before any legal proceedings in the Alexandria courts of Egypt.

Dr. Mona Fathy Abdel-Rahman
Lead Dentist – Alexandria Coastal Dental Clinic
Alexandria, Egypt Mr. Ahmed Hassan El-Sayed
Patient / Authorized Signatory
Date: _______________

Alexandria Coastal Dental Clinic – 12 Corniche El-Nil Street, Smouha, Alexandria, Egypt

Quotation Estimate No. QTE-2025-0417 | Issued: 15 June 2025 | Valid Until: 15 July 2025

This document was generated by the Alexandria Coastal Dental Clinic billing department. For inquiries regarding this Quotation Estimate, please contact our front desk at +20 3 555 1234 during clinic hours (Sunday–Thursday, 9:00 AM – 8:00 PM; Friday, 2:00 PM – 8:00 PM).

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