Quotation Estimate Dentist in Israel Jerusalem –Free Word Template Download with AI

1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After the expiration date, the Dentist practice reserves the right to revise pricing based on changes in material costs, labor rates, or regulatory adjustments within Israel Jerusalem.

2. Payment Schedule: The total patient responsibility amount of 8,320.00 NIS may be paid in full prior to the commencement of treatment, or in three equal installments of approximately 2,773.33 NIS, due at the initial consultation, mid-treatment, and final delivery of the ceramic crown. No interest will be charged on installment payments within the treatment period.

3. Insurance Coordination: Our Dentist office will submit all applicable claims directly to Maccabi Health Fund on your behalf. The estimated insurance coverage of 4,980.00 NIS is based on current Maccabi benefit schedules and is subject to final adjudication. Any discrepancy between the estimated and actual reimbursement will be communicated to the patient in writing within fourteen (14) business days.

4. Scope of Work: This Quotation Estimate covers only the procedures explicitly listed above. Should additional treatment be identified during the course of the planned procedures (e.g., unexpected pulp involvement, additional caries, or periodontal complications), the Dentist will pause work, inform the patient, and issue a supplementary Quotation Estimate for written approval before proceeding.

5. Warranty: All restorative work, including composite fillings and the zirconia ceramic crown, carries a warranty of twenty-four (24) months from the date of final placement. The root canal treatment carries a warranty of thirty-six (36) months. Warranty coverage is void in cases of trauma, neglect of oral hygiene, or damage caused by third parties.

6. Cancellation & Rescheduling: Appointments must be rescheduled or cancelled with a minimum of forty-eight (48) hours' notice. Cancellations made within this window will incur a fee of 200.00 NIS per missed appointment. This policy is standard for all Dentist practices operating in Israel Jerusalem and is designed to ensure efficient scheduling for all patients.

7. Regulatory Compliance: All procedures outlined in this Quotation Estimate will be performed in strict accordance with the Israeli Dental Practice Regulations (Regulations on Dental Practice, 5768-2008) and the standards established by the Israel Dental Association. Our practice in Israel Jerusalem maintains full compliance with all sterilization, infection control, and patient safety protocols mandated by the Ministry of Health.

8. Data Protection: Patient medical records and financial information are handled in accordance with the Israeli Privacy Protection Law, 5741-1981, and the updated Privacy Protection Regulations (Data Security), 5777-2017. No personal data will be shared with third parties without explicit written consent.