Quotation Estimate Dentist in Italy Rome –Free Word Template Download with AI
Professional Dental Care — Via del Corso 142, 00186 Roma (RM), Italy
P.IVA: IT01234567890 | Tel: +39 06 4951 2345 | Email: [email protected]
Licensed Dental Practice — Regione Lazio, ASL Roma 1 — Registration No. RM-2019-04521
Quotation Details
Reference No.: QE-2025-07842
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Currency: Euro (EUR) — Italian National Currency
Prepared By: Dr. Marco Esposito, DDS (Dentist)
Client Information
Name: Sig.ra Elena Marchetti
Address: Via Appia Nuova 87, 00179 Roma (RM), Italy
Phone: +39 333 876 5432
Email: [email protected]
Codice Fiscale: MRCELN75P42F205X
This Quotation Estimate has been prepared by our licensed Dentist at Studio Dentistico Roma Centro, located in the historic heart of Rome, Italy, following a comprehensive clinical examination and diagnostic imaging session conducted on 10 June 2025. The purpose of this document is to provide the client with a transparent, itemised breakdown of all proposed dental treatments, associated professional fees, and material costs. All pricing reflects the current fee schedule of our Rome-based dental practice and complies with the professional tariff guidelines established by the Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Roma.
Itemised Dental Treatment Plan & Costs| No. | Dental Procedure / Service | Dentist / Specialist | Qty | Unit Price (EUR) | Subtotal (EUR) |
|---|---|---|---|---|---|
| 1 | Full Intraoral Digital X-Ray & Panoramic OPG Imaging (Diagnostic) | Dr. M. Esposito | 1 | €120.00 | €120.00 |
| 2 | Comprehensive Periodontal Scaling & Root Planing (Full Mouth, 4 Quadrants) | Dr. M. Esposito | 4 | €185.00 | €740.00 |
| 3 | Composite Resin Restoration — Tooth #14 (Upper Right First Molar), 3-Surface | Dr. M. Esposito | 1 | €280.00 | €280.00 |
| 4 | Endodontic Treatment (Root Canal Therapy) — Tooth #21 (Upper Left Central Incisor) | Dr. L. Bianchi (Endodontist) | 1 | €650.00 | €650.00 |
| 5 | Custom Porcelain Crown (Zirconia) — Tooth #21, including Temporary Crown | Dr. L. Bianchi / Lab | 1 | €950.00 | €950.00 |
| 6 | Professional Dental Hygiene & Polishing (Post-Treatment Maintenance) | Dr. M. Esposito | 1 | €150.00 | €150.00 |
| 7 | Follow-Up Consultation & Occlusal Adjustment (2 Sessions) | Dr. M. Esposito | 2 | €80.00 | €160.00 |
| 8 | Prescription Medication & Post-Operative Care Kit (Antibiotics, Analgesics, Chlorhexidine Rinse) | Pharmacy / Practice | 1 | €45.00 | €45.00 |
| Subtotal (before VAT): | €3,095.00 | ||||
| VAT (IVA) — 22% (Italian Standard Rate): | €680.90 | ||||
| TOTAL AMOUNT DUE (EUR): | €3,775.90 | ||||
The above Quotation Estimate reflects the treatment plan recommended by our lead Dentist, Dr. Marco Esposito, following a thorough clinical assessment performed in our Rome clinic. The endodontic treatment on tooth #21 is essential to prevent further pulpal necrosis and potential periapical infection. The zirconia crown is recommended to restore full structural integrity and aesthetic harmony to the anterior dentition. All materials used in this practice are CE-certified and sourced from approved Italian and European dental laboratories. The client is advised that the total treatment timeline is estimated at approximately six to eight weeks, including laboratory fabrication time for the porcelain crown.
Terms & Conditions of This Quotation Estimate1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, prices may be subject to revision in accordance with the current fee schedule of the dental practice in Rome, Italy.
2. Payment Terms: A deposit of 30% (€1,132.78) is required to confirm the treatment booking and reserve laboratory slots. The remaining balance of 70% (€2,643.12) is due upon completion of the final procedure. Payment may be made via bank transfer (IBAN: IT60 X054 2811 1000 0000 0123 456), credit/debit card, or cash at the practice reception in Rome.
3. Cancellation Policy: Should the client wish to cancel or reschedule any scheduled dental appointment, a minimum of 48 hours' prior notice is required. Cancellations within 48 hours will incur a fee of 50% of the scheduled session cost.
4. Warranty: All restorative work (composite fillings, porcelain crowns) carries a two-year warranty from the date of placement, provided the client adheres to the recommended six-monthly hygiene recall schedule at our Rome dental practice.
5. Privacy & Data Protection: All patient data processed in connection with this Quotation Estimate and subsequent treatment is handled in strict compliance with the Italian Data Protection Code (D.Lgs. 196/2003) and the European General Data Protection Regulation (GDPR, EU 2016/679). The practice's privacy policy is available at the clinic and on our website.
6. Regulatory Compliance: This dental practice operates under the full regulatory oversight of the ASL Roma 1 (Azienda Sanitaria Locale) and the Ordine degli Odontoiatri della Provincia di Roma. All procedures listed in this Quotation Estimate are performed by registered, licensed dental professionals in Italy.
7. Dispute Resolution: Any disputes arising from this Quotation Estimate or the subsequent dental treatment shall be resolved in accordance with Italian civil law, with jurisdiction of the Tribunale di Roma.
Acceptance & SignaturesBy signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed dental treatment plan, and authorises the commencement of the procedures listed herein at the stated costs. The Dentist confirms that all information provided is accurate and that the treatment plan is in the best clinical interest of the patient.
For the Dental Practice (Rome, Italy)
Dr. Marco Esposito, DDSLead Dentist — Studio Dentistico Roma Centro
Signature & Date: ___________________________
Client Acknowledgement
Sig.ra Elena MarchettiSignature & Date: ___________________________ ⬇️ Download as DOCX Edit online as DOCX
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