Quotation Estimate Dentist in Germany Munich –Free Word Template Download with AI
Issued by a Licensed Dentist Practice in Munich, Germany
Dental Practice Dr. Markus WeberZahnarztpraxis am Isar
Maximilianstraße 142
80539 Munich (München), Germany
Phone: +49 89 555 0123
Email: [email protected]
USt-IdNr.: DE 298 765 431 Patient Details
Name: [Patient Full Name]
Address: [Patient Address], Munich, Germany
Date of Birth: [DD/MM/YYYY]
Health Insurance: [TK / AOK / BKK / Private]
Insurance No.: [XXXXXXXXXX]
1. Purpose of This Quotation Estimate
This Quotation Estimate has been prepared by our licensed Dentist practice in Munich, Germany, following a comprehensive clinical examination and diagnostic imaging (intraoral X-rays, panoramic radiograph, and periodontal charting) conducted on 12 June 2025. The purpose of this document is to provide the patient with a transparent, itemised breakdown of all recommended dental treatments, associated costs, and the portion covered by the statutory health insurance (gesetzliche Krankenversicherung) or private dental insurance applicable in Germany. All prices listed in this Quotation Estimate are in Euros (EUR) and include the applicable German value-added tax (Mehrwertsteuer) of 19% where applicable, in accordance with the German Tax Code (Abgabenordnung).
2. Itemised Treatment Plan and Cost Breakdown
| No. | Treatment / Procedure | GOZ / BEMA Code | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 1 | Comprehensive dental examination, periodontal screening, and diagnostic consultation by the Dentist | GOZ Nr. 1 | 1 | € 38.50 | € 38.50 |
| 2 | Panoramic radiograph (OPG) and 4 periapical X-rays | GOZ Nr. 2, 3 | 1 | € 62.40 | € 62.40 |
| 3 | Professional dental prophylaxis (scaling and polishing) – upper and lower arch | GOZ Nr. 1050 | 1 | € 145.00 | € 145.00 |
| 4 | Removal of carious lesion and composite restoration, tooth #16 (upper right first molar) | GOZ Nr. 2050, 2110 | 1 | € 210.00 | € 210.00 |
| 5 | Root canal treatment (endodontic therapy), tooth #21 (upper left central incisor), single canal | GOZ Nr. 2510, 2520 | 1 | € 385.00 | € 385.00 |
| 6 | Placement of a full ceramic crown (zirconia), tooth #21, including temporary crown | GOZ Nr. 2610, 2620 | 1 | € 620.00 | € 620.00 |
| 7 | Extraction of tooth #48 (lower right third molar / wisdom tooth), surgical removal under local anaesthesia | GOZ Nr. 1110, 1120 | 1 | € 295.00 | € 295.00 |
| 8 | Periodontal treatment – subgingival scaling and root planing, 4 quadrants | GOZ Nr. 1020 | 4 | € 88.00 | € 352.00 |
| 9 | Follow-up control visit and post-treatment evaluation by the Dentist (2 sessions) | GOZ Nr. 1 | 2 | € 38.50 | € 77.00 |
| 10 | Local anaesthesia (Lidocaine 2%) and consumables | GOZ Nr. 1000 | 3 | € 12.00 | € 36.00 |
| Grand Total (including 19% VAT where applicable) | € 2,219.90 | ||||
3. Insurance Coverage Information
As a Dentist practice operating in Munich, Germany, we are bound by the German Social Code Book V (Sozialgesetzbuch V) and the applicable fee schedules (GOÄ for private patients, GOZ for statutory insurance patients). For patients enrolled in statutory health insurance (GKV), the insurance fund will cover the basic treatment (Basisversorgung) as defined by the BEMA/GOZ catalogue. The patient is responsible for the difference between the recommended treatment and the basic coverage, as well as any additional aesthetic or premium material costs. For privately insured patients (PKV), coverage depends on the individual policy terms. Our practice in Munich will submit all relevant documentation to the respective insurance provider upon the patient's written request.
Note: This Quotation Estimate is a non-binding cost indication. Final billing may vary slightly depending on intra-operative findings. All treatments will be performed in strict compliance with the German Medical Profession Act (Berufsordnung für Ärzte) and the regulations of the Bavarian Medical Association (Bayerische Landesärztekammer). The patient retains the right to decline any or all recommended treatments without obligation.4. Terms and Conditions of This Quotation Estimate
4.1 Validity: This Quotation Estimate is valid for 90 calendar days from the date of issue. After this period, a revised estimate may be required due to changes in material costs, GOZ fee schedule updates, or the clinical condition of the patient's dentition.
4.2 Payment Terms: Payment is due within 14 days of the final invoice. Our practice in Munich accepts bank transfer (SEPA), EC card, and cash. For treatments exceeding € 500, a 30% deposit may be requested prior to the first appointment.
4.3 Cancellation Policy: Appointments must be cancelled at least 48 hours in advance. Late cancellations or no-shows may incur a fee of up to € 50, as permitted under German civil law (BGB § 280).
4.4 Data Protection: All patient data processed in connection with this Quotation Estimate is handled in accordance with the General Data Protection Regulation (GDPR / DSGVO) and the German Federal Data Protection Act (BDSG). Data is stored securely at our practice in Munich and will not be shared with third parties without explicit patient consent.
4.5 Governing Law: This Quotation Estimate and any resulting treatment agreement are governed by the laws of the Federal Republic of Germany. The competent court for any disputes is the local court (Amtsgericht) in Munich, Germany.
4.6 Warranties: All dental restorations and prosthetic work performed by our Dentist practice carry a warranty of 24 months, in accordance with standard German dental practice guidelines. This warranty does not cover damage caused by patient negligence, accidents, or failure to attend scheduled maintenance appointments.
5. Acceptance
By signing below, the patient acknowledges receipt of this Quotation Estimate and confirms understanding of the recommended treatment plan, associated costs, and terms. This signature does not constitute a binding contract for treatment but serves as confirmation that the patient has been informed by the Dentist of the proposed procedures and their estimated costs in Munich, Germany.
Patient SignatureName: ___________________________
Date: ___________________________ Dr. Markus Weber, Zahnarzt
Dental Practice Munich, Germany
Date: 15 June 2025 ⬇️ Download as DOCX Edit online as DOCX
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