Quotation Estimate Dentist in India Bangalore –Free Word Template Download with AI

This Quotation Estimate has been prepared by SmileCare Dental Clinic, a registered and licensed dental practice operating in Bangalore, India, to provide Mr. Rajesh Kumar Nair with a detailed, transparent, and itemized cost breakdown for the recommended comprehensive dental treatment. As a Dentist specializing in restorative and cosmetic procedures, Dr. Ananya Krishnamurthy has conducted a thorough clinical examination, radiographic assessment (OPG and periapical X-rays), and periodontal evaluation on 12 June 2025. The findings and subsequent treatment recommendations are outlined below. This document serves as a formal Quotation Estimate and does not constitute a binding contract until accepted in writing by the patient.

Following the clinical and radiographic examination conducted at our Bangalore, India facility, the following conditions were identified requiring intervention: moderate periodontal disease affecting multiple quadrants, two non-vital mandibular premolars requiring root canal therapy, a fractured maxillary molar requiring full-coverage restoration, generalized calculus deposits, and mild enamel erosion on the anterior teeth. The Dentist has recommended a phased treatment approach to ensure optimal outcomes and patient comfort.

• Advance Payment: 30% of the Grand Total (₹33,099) is due at the time of acceptance of this Quotation Estimate to schedule Phase 1 treatment.
• Phase-wise Payments: The remaining balance shall be payable in equal installments at the commencement of each treatment phase as outlined in Section 3.
• Accepted Payment Modes: UPI (GPay, PhonePe, Paytm), NEFT/RTGS, Credit/Debit Cards (Visa, Mastercard, RuPay), and Cash. A 2% convenience fee applies to card transactions.
• Tax Invoice: A GST-compliant tax invoice will be issued for each payment received, in accordance with the Goods and Services Tax Act, 2017, as applicable in Karnataka, India.

• This Quotation Estimate is valid for a period of 30 calendar days from the date of issue. Beyond this period, prices may be revised due to changes in material costs, laboratory charges, or applicable tax regulations in India.
• All dental procedures will be performed by qualified and registered Dentists at our Bangalore, India clinic in strict compliance with the Dental Council of India (DCI) guidelines and the Karnataka State Dental Council regulations.
• The Zirconia Crown carries a 5-year manufacturer warranty against material defects under normal use. Composite veneers carry a 2-year warranty. Warranty claims must be submitted in writing to the clinic.
• Patient consent forms, informed consent for anesthesia, and risk disclosure documents will be provided and signed prior to each procedure.
• In the event of a medical emergency or unforeseen clinical complication, the treating Dentist reserves the right to modify the treatment plan. The patient will be informed and a supplementary Quotation Estimate will be issued.
• This Quotation Estimate is non-transferable and is issued exclusively to the named patient. It does not guarantee insurance coverage. Patients are advised to verify pre-authorization with their respective health insurance providers (e.g., Star Health, HDFC Ergo, ICICI Lombard) before commencing treatment.
• Disputes, if any, arising from this Quotation Estimate shall be subject to the exclusive jurisdiction of the courts in Bangalore, Karnataka, India.

I, Mr. Rajesh Kumar Nair, hereby acknowledge that I have received, read, and understood this Quotation Estimate for dental treatment at SmileCare Dental Clinic, Bangalore, India. I confirm that the treating Dentist has explained the recommended procedures, associated risks, alternative options, and the total estimated cost. I voluntarily accept the terms and conditions outlined in this document and authorize the clinic to proceed with the treatment plan as described.