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Quotation Estimate Dentist in Japan Kyoto –Free Word Template Download with AI

12-34 Gionmachi, Higashiyama-ku, Kyoto 605-0001, Japan

Phone: +81-75-123-4567 | Email: [email protected]

Licensed Dentist Practice | Kyoto Prefecture Dental Association Member

Quotation Estimate

Quotation Details

Quotation No.: KYO-2025-04872

Date Issued: June 15, 2025

Valid Until: July 15, 2025

Prepared By: Dr. Haruki Tanaka, DDS

Client Information

Name: [Client Full Name]

Address: [Client Address], Kyoto, Japan

Phone: [Client Phone Number]

Email: [Client Email Address]

Dear Valued Patient,

Thank you for choosing Kyoto Sakuragaoka Dental Clinic for your dental care needs. As a trusted Dentist practice located in the heart of Japan Kyoto, we are committed to providing exceptional oral healthcare services that combine modern technology with the warmth and precision of traditional Japanese hospitality. This Quotation Estimate outlines the comprehensive dental treatment plan recommended following your recent consultation on June 10, 2025. All pricing is presented in Japanese Yen (JPY) and reflects our standard rates for services delivered at our Japan Kyoto clinic facility.

Itemized Services and Pricing
No. Dental Service Description Quantity Unit Price (JPY) Subtotal (JPY)
1 Comprehensive Oral Examination & Digital X-Ray (Panoramic + Periapical) 1 session ¥8,500 ¥8,500
2 Professional Dental Cleaning & Scaling (Ultrasonic + Hand Scaling) 2 sessions ¥12,000 ¥24,000
3 Root Canal Treatment (Upper Molar, 3 Canals) – Endodontic Procedure 1 tooth ¥65,000 ¥65,000
4 Ceramic Crown Restoration (Zirconia, 3D-CAD/CAM Fabricated) 1 unit ¥58,000 ¥58,000
5 Composite Resin Filling (Tooth #26, Medium Cavity) 1 tooth ¥15,000 ¥15,000
6 Periodontal Deep Cleaning (Scaling & Root Planing, 4 Quadrants) 1 course ¥45,000 ¥45,000
7 Fluoride Application & Occlusal Sealant (Preventive Care) 1 session ¥5,500 ¥5,500
8 Follow-up Consultation & Post-Treatment Evaluation (3 Visits) 3 visits ¥3,000 ¥9,000
9 Custom-Fabricated Night Guard (Bruxism Protection, Acrylic) 1 unit ¥22,000 ¥22,000
10 Intraoral Camera Photography & Digital Treatment Record 1 set ¥4,000 ¥4,000
Subtotal (Before Tax): ¥256,000
Consumable Materials & Lab Fees: ¥18,500
Consumption Tax (10%): ¥27,450
TOTAL ESTIMATED COST: ¥201,950
Important Note Regarding Japan Kyoto Healthcare: This Quotation Estimate reflects the full private-pay cost. If you are enrolled in Japan's National Health Insurance (Kokumin Kenko Hoken) or employee-based health insurance, a portion of the listed procedures may be covered under the standard 30% co-payment structure. Our front desk team in Kyoto will assist you in calculating your exact out-of-pocket expense based on your insurance coverage. Please bring your health insurance card (Kenpo Card) to your first appointment. Terms and Conditions of This Quotation Estimate
  • Validity: This Quotation Estimate is valid for thirty (30) days from the date of issue. After July 15, 2025, pricing may be subject to revision due to changes in material costs, laboratory fees, or regulatory adjustments within Japan Kyoto's healthcare framework.
  • Payment Schedule: A deposit of 30% (¥60,585) is required at the time of treatment confirmation. The remaining balance is due upon completion of the final procedure. We accept cash, credit cards (Visa, Mastercard, JCB, Amex), bank transfer, and Konbini payment methods common throughout Japan Kyoto.
  • Appointment Scheduling: As a busy Dentist practice serving the Kyoto metropolitan area, treatment sessions will be scheduled over a period of approximately six (6) weeks. Specific dates will be confirmed by our reception team within five business days of your approval of this Quotation Estimate.
  • Cancellations: Cancellations must be made at least 48 hours in advance. Late cancellations or no-shows may incur a fee of ¥5,000 per missed appointment, consistent with standard practice among Dentist offices in Japan Kyoto.
  • Warranty: All ceramic crowns and restorative work carry a two-year warranty against manufacturing defects. This warranty does not cover damage resulting from trauma, neglect, or failure to attend scheduled follow-up visits.
  • Confidentiality: All patient records, digital images, and treatment plans are handled in strict accordance with Japan's Personal Information Protection Act (PIPA). Your data will not be shared with third parties without written consent.
  • Scope of Services: This Quotation Estimate covers only the procedures listed above. Any additional treatments identified during the course of care will be communicated to you in writing before proceeding, and a supplementary Quotation Estimate will be issued at no charge.
About Our Dentist Practice in Japan Kyoto

Kyoto Sakuragaoka Dental Clinic has served the residents and visitors of Japan Kyoto for over fifteen years. Our team of licensed Dentist professionals, including Dr. Haruki Tanaka (Endodontics & Restorative Dentistry) and Dr. Yuki Sato (Periodontics & Preventive Care), operates from a state-of-the-art facility in the Higashiyama district. We utilize the latest in digital dentistry, including 3D intraoral scanners, CBCT imaging, and CAD/CAM crown fabrication, all while maintaining the personal, attentive care that defines our practice. Whether you are a long-term Kyoto resident or a traveler seeking quality dental care in Japan Kyoto, this Quotation Estimate represents our transparent commitment to fair pricing and outstanding clinical outcomes.

Dr. Haruki Tanaka, DDS
Lead Dentist, Kyoto Sakuragaoka Dental Clinic
Client Acknowledgment & Signature
Date: _______________

Kyoto Sakuragaoka Dental Clinic | 12-34 Gionmachi, Higashiyama-ku, Kyoto 605-0001, Japan

Quotation Estimate No. KYO-2025-04872 | This document is generated electronically and is valid without a physical seal (Inkan).

For inquiries regarding this Quotation Estimate, please contact our office at +81-75-123-4567 or visit us in Japan Kyoto during business hours (Mon–Sat, 9:00–18:00).

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