Quotation Estimate Dentist in Ghana Accra –Free Word Template Download with AI
Professional Dental Services — Accra, Ghana
Provider (Dentist)
Accra Premier Dental Clinic
12 Independence Avenue, Osu
Accra, Ghana
Tel: +233 30 277 4521
Email: [email protected]
Ghana Dental Council Reg. No.: GDC-2019-0487
Client / Patient
Mr. Kwame Asante
45 Ring Road East, Labone
Accra, Ghana
Tel: +233 24 555 8890
Email: [email protected]
National ID: GHA-1985-0042-771
This Quotation Estimate is issued by Accra Premier Dental Clinic, a fully licensed and registered Dentist practice operating in the heart of Ghana Accra, to provide a comprehensive breakdown of all proposed dental treatments, diagnostic procedures, and associated materials. The following services have been recommended following a full clinical examination and radiographic assessment conducted on 10 June 2025 at our Osu, Accra facility. All pricing reflects current market rates in Ghana Accra and includes the expertise of our qualified dental team.
| # | Service / Procedure | Description | Qty | Unit Price (GH₵) | Total (GH₵) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Consultation | Full oral assessment, medical history review, and treatment planning by the lead Dentist | 1 | 350.00 | 350.00 |
| 2 | Full-Mouth Digital X-Ray (Panoramic & Periapical) | Digital radiographic imaging for diagnostic purposes at our Accra facility | 1 | 480.00 | 480.00 |
| 3 | Ultrasonic Scaling & Polishing (Prophylaxis) | Removal of calculus, tartar, and plaque buildup; professional polishing | 1 | 650.00 | 650.00 |
| 4 | Composite Resin Filling (Tooth #14 & #21) | Restoration of two posterior and anterior teeth using 3M Z350 composite material | 2 | 850.00 | 1,700.00 |
| 5 | Root Canal Treatment (Tooth #26) | Endodontic therapy including access, instrumentation, obturation, and temporary restoration | 1 | 3,200.00 | 3,200.00 |
| 6 | Porcelain Crown (Tooth #26) | Custom-fabricated full ceramic crown, lab work included, cementation by the Dentist | 1 | 4,500.00 | 4,500.00 |
| 7 | Extraction of Impacted Wisdom Tooth (Tooth #38) | Surgical extraction under local anaesthesia with suturing and post-operative instructions | 1 | 1,800.00 | 1,800.00 |
| 8 | Professional Teeth Whitening (In-Clinic) | Single-visit LED-activated whitening treatment using hydrogen peroxide gel | 1 | 1,200.00 | 1,200.00 |
| 9 | Follow-Up Consultation & Post-Operative Review | Two follow-up visits within 30 days for healing assessment and adjustment | 2 | 200.00 | 400.00 |
| 10 | Prescription Medication & Aftercare Kit | Antibiotics, analgesics, chlorhexidine mouthwash, and soft-bristle toothbrush | 1 | 320.00 | 320.00 |
| Subtotal (GH₵) | 14,600.00 |
| VAT @ 15% (Ghana Revenue Authority) | 2,190.00 |
| NHIL @ 2.5% | 365.00 |
| GETFund Levy @ 2.5% | 365.00 |
| Local Content Levy @ 1% | 146.00 |
| GRAND TOTAL (GH₵) | 17,666.00 |
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to revision upon expiry due to fluctuations in material costs within Ghana Accra.
- A non-refundable deposit of fifty percent (50%) of the grand total, amounting to GH₵ 8,833.00, is required to schedule and confirm the treatment plan. The remaining balance is due upon completion of all procedures.
- All dental procedures will be performed by a registered and licensed Dentist in compliance with the standards set by the Ghana Dental Council and the Ministry of Health, Republic of Ghana.
- Payment may be made via bank transfer to our designated account at Ecobank Ghana (Accra branch), mobile money (MTN MoMo / Telecel Cash), or by debit/credit card at the clinic reception.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic or functional outcomes. The treating Dentist will exercise professional clinical judgement during the course of treatment.
- Any additional procedures identified during the course of treatment that are not included in this estimate will be communicated to the patient in writing prior to commencement, with a supplementary Quotation Estimate provided.
- The clinic operates Monday through Saturday, 8:00 AM to 6:00 PM, at our location in Osu, Accra. Emergency appointments may be arranged by telephone.
- All patient records, radiographs, and clinical notes are maintained in accordance with Ghana's Data Protection Act, 2012 (Act 843) and the clinic's confidentiality policy.
- This Quotation Estimate is prepared exclusively for the named client and may not be transferred or assigned to a third party without prior written consent from Accra Premier Dental Clinic.
- Disputes arising from this Quotation Estimate shall be resolved through amicable negotiation, failing which they shall be subject to the jurisdiction of the courts of Ghana, Accra.
For and on behalf of Accra Premier Dental Clinic
Dr. Efua Mensah, DDSLead Dentist & Practice Owner
Date: _______________
Accepted by Client / Patient
Mr. Kwame AsanteSignature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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