Quotation Estimate Dentist in Israel Tel Aviv –Free Word Template Download with AI
45 Dizengoff Street, Tel Aviv-Yafo, Israel 64239 | Tel: +972-3-512-4567 | Email: [email protected]
License No. IL-2019-004521 | Registered with the Israeli Ministry of Health
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-03847
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Currency: Israeli New Shekel (ILS / ₪)
Client Information
Name: Mr. Daniel Cohen
Address: 12 Rothschild Blvd, Tel Aviv, Israel
ID No.: 2-XXXXXXXXX
Phone: +972-52-XXX-XXXX
Email: [email protected]
Dear Mr. Cohen,
Thank you for visiting our Dentist practice here in Israel Tel Aviv. Following your comprehensive consultation and diagnostic examination conducted on 10 June 2025, we are pleased to present this formal Quotation Estimate outlining the proposed treatment plan, associated costs, and all relevant terms. This Quotation Estimate has been prepared specifically for your dental needs and reflects the current pricing standards maintained by our Dentist team at our Israel Tel Aviv location.
Itemized Treatment Plan & Cost Breakdown| No. | Dental Procedure / Service | Description | Qty | Unit Price (₪) | Subtotal (₪) |
|---|---|---|---|---|---|
| 1 | Full Oral Examination & Digital X-Rays | Comprehensive diagnostic assessment by our lead Dentist, including panoramic and periapical radiographs | 1 | 450.00 | 450.00 |
| 2 | Professional Dental Cleaning (Scaling & Polishing) | Ultrasonic scaling, air-polishing, and fluoride application performed by our licensed Dentist | 1 | 650.00 | 650.00 |
| 3 | Composite Tooth-Colored Fillings (Teeth #14, #24) | Removal of decay and restoration with premium composite resin material, shade-matched by our Dentist | 2 | 850.00 | 1,700.00 |
| 4 | Root Canal Treatment (Tooth #36) | Endodontic therapy including access cavity, canal preparation, obturation, and temporary restoration by our specialist Dentist | 1 | 3,200.00 | 3,200.00 |
| 5 | Ceramic Crown (Tooth #36) | Full zirconia ceramic crown, custom-fabricated and cemented by our Dentist after root canal completion | 1 | 4,500.00 | 4,500.00 |
| 6 | Wisdom Tooth Extraction (Tooth #48) | Surgical removal of impacted lower right third molar under local anesthesia, performed by our oral surgery Dentist | 1 | 2,800.00 | 2,800.00 |
| 7 | Follow-Up Visits & Post-Operative Care | Two scheduled follow-up appointments with our Dentist for healing assessment and adjustment | 2 | 200.00 | 400.00 |
| 8 | Prescription Medication & Aftercare Kit | Antibiotics, analgesics, and post-extraction care kit as prescribed by our Dentist | 1 | 180.00 | 180.00 |
| Subtotal (before VAT): | 13,880.00 | ||||
| VAT (18%): | 2,498.40 | ||||
| TOTAL ESTIMATED COST: | 16,378.40 | ||||
All prices are quoted in Israeli New Shekels (ILS). VAT of 18% is included as per Israeli tax regulations. This Quotation Estimate is subject to final confirmation after clinical verification by our Dentist.
Terms & Conditions of This Quotation Estimate1. Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be adjusted to reflect current material costs and the prevailing fee schedule of our Dentist practice in Israel Tel Aviv.
2. Payment Schedule: A deposit of 30% (₪4,913.52) is required to confirm your appointment and secure your treatment slot with our Dentist. The remaining balance of 70% (₪11,464.88) is due upon completion of all procedures. We accept bank transfer, credit card (Visa, Mastercard, Amex), and cash payments at our Israel Tel Aviv clinic.
3. Insurance & HMO Coverage: Please note that this Quotation Estimate reflects full private-pay pricing. If you hold coverage through an Israeli HMO (Maccabi, Clalit, Meuhedet, or HPO), certain procedures may be partially reimbursed. Our front desk team in Israel Tel Aviv will assist you in submitting claims and verifying your entitlements prior to treatment.
4. Treatment Modifications: In the unlikely event that our Dentist identifies additional or alternative clinical needs during the course of treatment, a revised Quotation Estimate will be provided and your written consent will be obtained before any additional work commences.
5. Cancellation Policy: Appointments must be rescheduled at least 48 hours in advance. Cancellations within 48 hours will incur a fee of 50% of the scheduled procedure cost as billed by our Dentist.
6. Warranties: All restorative work (crowns, fillings) carries a two-year warranty from our Dentist. Root canal treatment carries a five-year warranty. Warranties are void in cases of trauma, neglect, or failure to attend scheduled follow-up visits.
7. Regulatory Compliance: All procedures are performed in full compliance with the Israeli Ministry of Health regulations, the Israeli Dental Association standards, and the professional ethics code governing every Dentist licensed to practice in Israel Tel Aviv and throughout the State of Israel.
8. Confidentiality: All patient records, radiographic images, and financial details associated with this Quotation Estimate are protected under Israeli privacy law (Privacy Protection Law, 5741-1981) and will not be disclosed to any third party without your explicit written consent.
Acceptance & AuthorizationBy signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed treatment plan, and authorizes the Dentist team at Tel Aviv Dental Clinic, Israel Tel Aviv, to proceed with the outlined procedures upon payment of the required deposit.
Client Signature & DateMr. Daniel Cohen
Dentist / Authorized PractitionerDr. Miriam Levi, DDS, MSc
Licensed Dentist, Israel Tel Aviv
Tel Aviv Dental Clinic
Israel Tel Aviv
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