Quotation Estimate Dentist in India New Delhi –Free Word Template Download with AI
Professional Dental Services — Dentist Practice, New Delhi, India
Official Quotation Estimate DocumentDental Practice Details
Dr. Ananya Sharma, BDS, MDS (Prosthodontics)
SmileCare Dental Clinic
2nd Floor, Connaught Place, Block E
New Delhi, India — 110001
Phone: +91-11-4567-8900
Email: [email protected]
Reg. No.: DMC/ND/2019/4521
Client Details
Mr. Rajesh Kumar Verma
14, Lajpat Nagar, Market Road
New Delhi, India — 110024
Phone: +91-98765-43210
Email: [email protected]
PAN: ABCDE1234F
Quotation Estimate No.: SCE/ND/2025/00487
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Referral Source: Walk-in Consultation
Consultation Date: 10 June 2025
Prepared By: Dr. Ananya Sharma
Dear Mr. Verma,
Thank you for visiting SmileCare Dental Clinic in New Delhi, India. Following your comprehensive dental examination and consultation on 10 June 2025, we are pleased to present this detailed Quotation Estimate for the recommended dental treatment plan. This Quotation Estimate outlines all procedures, materials, and associated costs for your complete dental care as a patient of our Dentist practice in New Delhi, India. All prices are quoted in Indian Rupees (INR) and are inclusive of applicable Goods and Services Tax (GST) at 18% as per the Government of India regulations.
| S.No. | Dental Procedure / Service | Description | Qty | Unit Price (INR) | Total Amount (INR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Ray (OPG + IOPA) | Full oral assessment, panoramic and intraoral radiographs | 1 | ₹ 2,500 | ₹ 2,500 |
| 2 | Ultrasonic Scaling & Polishing (Full Mouth) | Removal of calculus, tartar, and plaque; professional polishing | 1 | ₹ 3,200 | ₹ 3,200 |
| 3 | Root Canal Treatment (RCT) — Molar Tooth (Tooth #36) | Multi-visit endodontic procedure with gutta-percha obturation | 1 | ₹ 12,000 | ₹ 12,000 |
| 4 | Full Ceramic Crown (Zirconia) — Tooth #36 | Custom-fabricated zirconia crown, 3D CAD/CAM milled | 1 | ₹ 15,500 | ₹ 15,500 |
| 5 | Composite Resin Filling — Tooth #24 (Mesial Surface) | Esthetic tooth-colored composite restoration | 1 | ₹ 2,800 | ₹ 2,800 |
| 6 | Extraction of Impacted Wisdom Tooth (Tooth #48) | Surgical extraction under local anesthesia with suturing | 1 | ₹ 5,500 | ₹ 5,500 |
| 7 | Professional Teeth Whitening (In-Office, Zoom System) | Single-session LED-activated whitening treatment | 1 | ₹ 8,000 | ₹ 8,000 |
| 8 | Follow-up Consultations & Post-Operative Reviews | Three follow-up visits included (Week 1, Week 4, Month 3) | 3 | ₹ 500 | ₹ 1,500 |
| 9 | Prescription Medications & Post-Extraction Care Kit | Antibiotics, analgesics, antiseptic mouthwash, ice pack | 1 | ₹ 1,200 | ₹ 1,200 |
| Subtotal (Inclusive of 18% GST): | ₹ 52,200 | ||||
| Discount (Loyalty Member — 5%): | ₹ −2,610 | ||||
| Grand Total (Payable Amount): | ₹ 49,590 | ||||
As a Dentist practice operating in New Delhi, India, we offer flexible payment options to ensure your comfort and convenience. The total Quotation Estimate amount of ₹ 49,590 may be paid as follows:
- Option A — Full Payment: 100% at the time of treatment commencement. A 2% early-payment discount of ₹ 992 will be applied, reducing the final payable amount to ₹ 48,598.
- Option B — Installment Plan: 40% advance (₹ 19,836) at booking, 30% after RCT completion (₹ 14,877), and 30% upon final crown delivery (₹ 14,877).
- Option C — No-Cost EMI: Available through partner banks (HDFC, ICICI, SBI) for 3 or 6 months. No additional interest charged.
Accepted payment modes: UPI (GPay, PhonePe, Paytm), NEFT/RTGS, Credit/Debit Cards, and Cash. A GST-compliant tax invoice will be issued for every transaction as mandated by the Indian Revenue Service.
- This Quotation Estimate is valid for a period of thirty (30) days from the date of issue. Beyond this period, prices may be revised based on material cost fluctuations in the Indian dental supply market.
- All dental procedures will be performed by Dr. Ananya Sharma or her designated senior associate Dentist at the SmileCare Dental Clinic premises in Connaught Place, New Delhi, India.
- The Quotation Estimate includes all standard materials, sterilization protocols, and post-operative instructions. Any additional procedures identified during treatment (e.g., unexpected complications) will be communicated to the patient in writing before proceeding, with a revised Quotation Estimate issued.
- A warranty of twelve (12) months is provided on the zirconia crown and composite filling. The warranty covers material defects and does not cover damage due to trauma, negligence, or failure to attend scheduled follow-up appointments.
- The patient agrees to attend all follow-up consultations as specified. Cancellation of an appointment with less than 24 hours' notice may incur a fee of ₹ 500.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. The Dentist will use reasonable professional judgment in achieving the best possible result within the scope of the recommended treatment.
- In the event of any dispute, this Quotation Estimate shall be governed by the laws of India, and the competent courts in New Delhi, India shall have exclusive jurisdiction.
- Medical records and radiographs will be maintained in accordance with the Medical Council of India (MCI) guidelines and the Digital Personal Data Protection Act, 2023.
By signing below, the patient acknowledges receipt of this Quotation Estimate, agrees to the terms and conditions outlined above, and authorizes the Dentist at SmileCare Dental Clinic, New Delhi, India, to proceed with the recommended treatment plan.
For SmileCare Dental ClinicDr. Ananya Sharma, BDS, MDS
Dentist — New Delhi, India
Date: _______________ Patient / Authorized Signatory
Mr. Rajesh Kumar Verma
New Delhi, India
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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