Quotation Estimate Dentist in France Marseille –Free Word Template Download with AI
Dentist Practice — Marseille, France
12 Rue de la République, 13001 Marseille, Bouches-du-Rhône, France
Tél: +33 (0)4 91 55 22 87 | Email: [email protected]
RCS Marseille B 842 567 391 | ADELI: 1310045678
Quotation Reference: QE-2025-MRS-0487Date of Issue: 14 June 2025
Valid Until: 14 September 2025 (90 days) Prepared For:
Mr. Jean-Luc Moreau
45 Avenue du Prado
13008 Marseille, France
Sécurité Sociale N°: 84 12 13 78 945 678 91
1. Purpose of This Quotation Estimate
This Quotation Estimate has been prepared by the undersigned Dentist at Cabinet Dentaire du Vieux-Port, a registered dental practice located in the heart of Marseille, France. The purpose of this document is to provide Mr. Jean-Luc Moreau with a detailed, itemized financial projection of the dental treatments recommended following the comprehensive clinical examination conducted on 10 June 2025. As a Dentist operating under the regulatory framework of the French Ordre des Médecins Dentistes and in full compliance with the Code de la Santé Publique, this Quotation Estimate reflects the standard fee schedule applicable in the Marseille region for the calendar year 2025.
Please note that this Quotation Estimate is a good-faith projection and does not constitute a binding contract. Final costs may vary slightly depending on the clinical findings during the actual treatment sessions. All prices listed are in Euros (€) and include applicable French Value Added Tax (TVA) at the standard rate of 20%, unless otherwise specified.
2. Itemized Dental Services — Quotation Estimate Breakdown
| Ref. | Dental Procedure / Service | CCAM Code | Quantity | Unit Price (€) | Subtotal (€) |
|---|---|---|---|---|---|
| 01 | Full intraoral radiographic examination (panoramic + 4 periapical views) | RA001 | 1 | 85.00 | 85.00 |
| 02 | Professional dental hygiene and scaling (ultrasonic + manual) | RA002 | 1 | 120.00 | 120.00 |
| 03 | Composite resin restoration — molar, tooth #36 (lower left) | RA003 | 1 | 245.00 | 245.00 |
| 04 | Root canal treatment (endodontics) — premolar, tooth #24 (upper right) | RA004 | 1 | 480.00 | 480.00 |
| 05 | Ceramic inlay restoration — tooth #24 (post-endodontic) | RA005 | 1 | 620.00 | 620.00 |
| 06 | Extraction of impacted third molar (wisdom tooth), tooth #48 | RA006 | 1 | 350.00 | 350.00 |
| 07 | Local anaesthesia and post-operative care (included in extraction) | RA007 | 1 | 45.00 | 45.00 |
| 08 | Follow-up consultation and suture removal (week 2) | RA008 | 1 | 60.00 | 60.00 |
| 09 | Fluoride varnish application (preventive, full arch) | RA009 | 1 | 55.00 | 55.00 |
| 10 | Prophylactic sealant — molars #16, #26, #36, #46 | RA010 | 4 | 38.00 | 152.00 |
| TOTAL ESTIMATED COST (TTC — Tax Included): | € 2,212.00 | ||||
3. Sécurité Sociale Reimbursement Estimate (France)
Note: As a Dentist registered in Marseille, France, the following treatments are partially or fully covered by the French national health insurance (Assurance Maladie). The estimated reimbursement at the standard 70% rate (with potential 100% coverage under the 100% Santé program for eligible patients) is provided for informational purposes only. The patient is responsible for any remaining balance (ticket modérateur and dépassement d'honoraires).| Category | Estimated Sécurité Sociale Reimbursement (€) | Patient Out-of-Pocket Estimate (€) |
|---|---|---|
| Consultations, radiographs, hygiene | 210.00 | 100.00 |
| Restorations and endodontics | 385.00 | 960.00 |
| Extraction and surgical procedures | 195.00 | 200.00 |
| Preventive treatments (fluoride, sealants) | 85.00 | 122.00 |
| TOTALS | € 875.00 | € 1,337.00 |
4. Terms and Conditions of This Quotation Estimate
- Validity: This Quotation Estimate is valid for a period of ninety (90) days from the date of issue. After this period, a revised Quotation Estimate may be required due to potential changes in material costs or French regulatory fee adjustments.
- Payment Schedule: Payment may be arranged in up to three (3) instalments: 40% upon acceptance of this Quotation Estimate, 40% upon completion of the primary restorative work, and 20% at the final follow-up consultation. The Dentist at this Marseille practice accepts bank transfer, credit/debit card, and direct Sécurité Sociale electronic settlement (Tiers Payant).
- 100% Santé Program: Where applicable, the Dentist will apply the 100% Santé reimbursement framework as mandated by French law for patients enrolled in a complementary health insurance plan (mutuelle) compliant with the Loi de Modernisation de notre Système de Santé (2016).
- Cancellation Policy: Appointments must be cancelled at least 48 hours in advance. Late cancellations or no-shows within the Marseille practice will incur a fee of €50.00 per missed session.
- Warranty: All restorative work performed by this Dentist carries a two-year warranty against material defects, in accordance with French consumer protection law (Code de la Consommation, Articles L217-1 et seq.).
- Regulatory Compliance: This dental practice in Marseille, France operates in full compliance with the Décret n° 2018-1399, the Ordre National des Chirurgiens-Dentistes regulations, and all applicable EU medical device and radiological safety directives.
- Confidentiality: All patient data processed in connection with this Quotation Estimate is handled in strict accordance with the French Data Protection Act (Loi Informatique et Libertés) and the European General Data Protection Regulation (GDPR).
5. Acceptance and Signatures
By signing below, the patient acknowledges receipt of this Quotation Estimate from the Dentist at Cabinet Dentaire du Vieux-Port, Marseille, France, and confirms understanding of the estimated costs, the Sécurité Sociale reimbursement framework, and the terms and conditions outlined herein. This signature does not obligate the patient to proceed with all recommended treatments; the patient retains the right to accept, decline, or modify the treatment plan at any time.
Patient: Mr. Jean-Luc Moreau
Signature & DateDentist: Dr. Sophie Lefebvre, Chirurgen-Dentiste
RPPS: 1010123456 — Marseille, France
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