Quotation Estimate Dentist in France Lyon –Free Word Template Download with AI
12 Quai de Serbie, 69002 Lyon, France
Tel: +33 4 78 00 00 00 | Email: [email protected]
RCS Lyon: 842 567 891 | SIRET: 842 567 891 00012
Quotation Estimate Ref: QE-2025-0472Prepared For (Patient)
Name: Mr. Jean-Pierre Moreau
Address: 45 Rue de la République, 69002 Lyon, France
Phone: +33 6 12 34 56 78
Email: [email protected]
Insurance: CPAM Lyon – Mutuelle Harmonie Mutuelle
File No.: PAT-2025-0389
Quotation Details
Date of Issue: 14 June 2025
Valid Until: 14 September 2025 (90 days)
Prepared By: Dr. Marie-Claire Fontaine
Location: Lyon, France – 2nd Arrondissement
Currency: Euro (EUR)
Language: English / Français
This Quotation Estimate has been prepared by our Dentist practice in France Lyon following a comprehensive clinical examination conducted on 10 June 2025. The following itemised breakdown reflects the full scope of recommended dental procedures, diagnostic imaging, and associated professional fees. As a registered Dentist operating within the city of Lyon, France, all services listed herein comply with the French National Order of Dentists (Ordre National des Chirurgiens-Dentistes) regulations and the applicable tariff framework established by the Assurance Maladie for the Lyon metropolitan area.
| Ref | Dental Procedure / Service | Description | Unit | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|---|
| 01 | Full Intraoral Radiographic Examination | Digital panoramic X-ray (OPG) and 6 periapical radiographs for comprehensive diagnostic assessment | Session | 1 | 85.00 | 85.00 |
| 02 | Full Mouth Scaling and Root Planing | Ultrasonic and manual periodontal debridement, all four quadrants, including subgingival access | Session | 2 | 220.00 | 440.00 |
| 03 | Composite Resin Restoration (Tooth #16) | Multi-surface Class II composite filling, shade-matched, including bonding agent and polishing | Tooth | 1 | 195.00 | 195.00 |
| 04 | Endodontic Treatment – Root Canal (Tooth #21) | Single-root canal therapy including access cavity, instrumentation, obturation, and temporary restoration | Tooth | 1 | 480.00 | 480.00 |
| 05 | Full-Ceramic Crown (Tooth #21) | Custom zirconia crown fabricated by Lyon dental laboratory, including try-in and final cementation | Tooth | 1 | 650.00 | 650.00 |
| 06 | Extraction – Impacted Wisdom Tooth (Tooth #48) | Surgical extraction under local anaesthesia, including suturing and post-operative instructions | Tooth | 1 | 320.00 | 320.00 |
| 07 | Professional Teeth Whitening (In-Office) | Single-session LED-activated whitening protocol, including pre-treatment shade assessment and post-treatment sensitivity gel | Session | 1 | 350.00 | 350.00 |
| 08 | Follow-Up Consultation and Review | Post-treatment clinical review at 6 weeks, including radiographic verification and periodontal re-assessment | Visit | 1 | 60.00 | 60.00 |
| 09 | Local Anaesthetic and Consumables | Articaine 4% with adrenaline, bonding kits, impression materials, and disposable instruments | Lot | 1 | 45.00 | 45.00 |
| 10 | Post-Operative Medication and Care Kit | Analgesic prescription, antiseptic mouthwash, and soft-bristle toothbrush for healing period | Kit | 1 | 35.00 | 35.00 |
| TOTAL ESTIMATED COST (Before Tax) | 2,660.00 | |||||
| TVA (VAT) 20% – Applicable in France | 532.00 | |||||
| GRAND TOTAL (EUR) | 3,192.00 | |||||
Please note that as a Dentist registered in Lyon, France, the fees quoted above are subject to the French healthcare reimbursement system. The base amount (Base de Remboursement) for each procedure will be reimbursed by the CPAM (Caisse Primaire d'Assurance Maladie) for the Lyon region at the standard rate. Your supplementary mutual insurance (Harmonie Mutuelle) will cover the remaining balance according to your specific contract terms. A detailed "Attestation de droits" should be provided prior to the commencement of treatment to ensure accurate billing and minimisation of out-of-pocket expenses. This Quotation Estimate does not constitute a final invoice; actual costs may vary slightly depending on clinical findings during the procedure.
- This Quotation Estimate is valid for a period of ninety (90) days from the date of issue. After this period, a revised estimate may be required due to potential changes in material costs or clinical condition.
- Payment is due within thirty (30) days of the final invoice date. A 10% deposit is required to schedule the first treatment session at our Lyon, France clinic.
- All dental procedures will be performed by Dr. Marie-Claire Fontaine or a qualified associate Dentist within the Cabinet Dentaire du Rhône practice in Lyon, France.
- The patient consents to the use of digital imaging and electronic medical records in accordance with French data protection regulations (RGPD / GDPR).
- Any additional procedures identified during treatment that were not included in this Quotation Estimate will be communicated to the patient in writing before execution, with a supplementary estimate provided.
- Cancellations must be made at least 48 hours in advance. Late cancellations or no-shows will incur a fee of 50% of the scheduled session cost.
- This Quotation Estimate is governed by French law. Any disputes shall be subject to the jurisdiction of the Tribunal Judiciaire de Lyon, France.
- The Dentist practice in Lyon, France maintains full professional liability insurance (RC Pro) with AXA France, Policy No. AXA-2025-784512, covering all services listed herein.
By signing below, the patient acknowledges receipt of this Quotation Estimate and authorises the Dentist practice in France Lyon to proceed with the dental treatments as described. The patient confirms that all information provided is accurate and that they have had the opportunity to ask questions regarding the proposed treatment plan, associated risks, and alternative options.
Patient SignatureMr. Jean-Pierre Moreau
Date: _______________ Dentist / Practice Signature
Dr. Marie-Claire Fontaine, DMD
Cabinet Dentaire du Rhône, Lyon, France
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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