Quotation Estimate Dentist in France Paris –Free Word Template Download with AI
Dental Services — Paris, France
Document Reference: QTE-PAR-2025-04872 | Issued in Paris, France
Clinique Dentaire du Louvre14 Rue de Rivoli, 75001 Paris, France
Tel: +33 (0)1 42 60 33 18
Email: [email protected]
SIRET: 842 567 391 00021
RCP: AXA France — Policy No. 78-4421-009 Quotation Date: 14 June 2025
Valid Until: 14 July 2025
Prepared By: Dr. Émile Fontaine, DMD
Order No.: ORD-2025-04872
| Patient Name: | Mr. James A. Whitfield |
| Address: | 27 Avenue des Champs-Élysées, 75008 Paris, France |
| Phone: | +33 (0)6 72 44 89 01 |
| Insurance / Mutuelle: | CPAM Île-de-France — No. 1 85 04 75 123 456 789 |
| Complementary Insurance: | Harmonie Mutuelle — Contract No. HM-2024-88341 |
This Quotation Estimate has been prepared by the dental team at Clinique Dentaire du Louvre, located in the heart of Paris, France, following a comprehensive clinical examination and diagnostic imaging session conducted on 10 June 2025. The following itemised costs represent the estimated fees for the proposed dental treatment plan. All prices are quoted in Euros (EUR) and are inclusive of applicable French Value Added Tax (TVA) at the standard rate of 20%, unless otherwise noted. This Quotation Estimate is specific to the dental services rendered in Paris, France, and reflects current pricing as of the date of issue.
| Ref. | Dental Procedure / Service | Description | Unit Price (EUR) | Qty | Subtotal (EUR) |
|---|---|---|---|---|---|
| 01 | Full Oral Examination & Diagnostic Consultation | Initial assessment, intraoral photography, and clinical review by Dr. Fontaine | 120.00 | 1 | 120.00 |
| 02 | Panoramic Radiograph (Orthopantomogram) | Digital X-ray imaging of full jaw structure, performed in Paris clinic | 85.00 | 1 | 85.00 |
| 03 | Periapical Radiographs (4 views) | Targeted X-rays for posterior teeth assessment | 22.00 | 4 | 88.00 |
| 04 | Ultrasonic Scaling & Polishing (Prophylaxis) | Full-mouth periodontal cleaning, supragingival and subgingival | 180.00 | 1 | 180.00 |
| 05 | Composite Resin Restoration (Tooth #26) | Direct composite filling, medium cavity, A2 shade | 220.00 | 1 | 220.00 |
| 06 | Root Canal Treatment (Tooth #36) | Single-visit endodontic therapy with rotary instrumentation | 650.00 | 1 | 650.00 |
| 07 | Ceramic Crown (Tooth #36) | Full zirconia crown, milled in Paris laboratory, 2-visit protocol | 1,150.00 | 1 | 1,150.00 |
| 08 | Extraction of Tooth #48 (Wisdom Tooth) | Surgical extraction under local anaesthesia, sutures included | 380.00 | 1 | 380.00 |
| 09 | Follow-up Consultation & Suture Removal | Post-operative review at 7-day interval, Paris clinic | 60.00 | 1 | 60.00 |
| 10 | Prescription & Post-Operative Medication | Analgesics and anti-inflammatory (per French pharmacy regulations) | 35.00 | 1 | 35.00 |
| Subtotal (HT — Hors Taxes): | 3,168.00 EUR |
| TVA 20% (French VAT): | 633.60 EUR |
| TOTAL ESTIMATED COST (TTC — Toutes Taxes Comprises): | 3,801.60 EUR |
- Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue (14 June 2025 to 14 July 2025). After this period, prices may be revised to reflect current dental material costs in the Paris, France market.
- Estimate Nature: This document constitutes a Quotation Estimate and not a binding contract. Final costs may vary by up to 10% depending on clinical findings during the actual dental treatment sessions. Any significant deviation will be communicated to the patient prior to proceeding.
- Payment Terms: A deposit of 30% (1,140.48 EUR TTC) is required to confirm the treatment schedule. The remaining balance is due upon completion of the final dental procedure. Payment may be made by bank transfer (IBAN: FR76 3000 4000 0300 0012 3456 789), credit card, or in cash at the Paris clinic reception.
- Insurance Processing: The clinic will submit the S1 form (feuille de soins) directly to CPAM Île-de-France on the patient's behalf. The patient must present their Carte Vitale at each dental appointment in Paris.
- Cancellation Policy: Appointments may be rescheduled up to 48 hours in advance without charge. Late cancellations or no-shows will incur a fee of 50% of the scheduled procedure cost.
- Warranty: All dental restorations and crowns carry a 24-month warranty from the date of placement, provided the patient adheres to the recommended maintenance schedule at this Paris, France clinic.
- Regulatory Compliance: All dental services are performed in accordance with the French Public Health Code (Code de la Santé Publique) and the regulations of the Ordre des Chirurgiens-Dentistes de France. The clinic operates under the professional licence No. 75-CD-2019-00432.
- Dispute Resolution: Any disagreement regarding this Quotation Estimate or the dental services provided shall be subject to the jurisdiction of the Tribunal Judiciaire de Paris, France.
By signing below, the patient acknowledges receipt of this Quotation Estimate for dental services in Paris, France, and agrees to the terms and conditions outlined above. This signature does not constitute a commitment to proceed with all listed procedures but authorises the clinic to reserve the proposed treatment dates.
Patient SignatureMr. James A. Whitfield
Date: _______________ Dentist / Clinic Representative
Dr. Émile Fontaine, DMD
Clinique Dentaire du Louvre, Paris, France
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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