Quotation Estimate Dentist in Mexico Mexico City –Free Word Template Download with AI
Av. Paseo de la Reforma 245, Piso 3, Col. Juárez, Cuauhtémoc
Mexico City, CDMX, Mexico 06600
Tel: +52 (55) 5512 3456 | Email: [email protected]
RFC: SDM180515QX7 | SAT Registered Dental Practice
Quotation EstimateQuotation Details
Quotation No.: QE-2025-07842
Date Issued: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Currency: Mexican Pesos (MXN)
Client Information
Name: María Fernanda López Gutiérrez
Address: Calle Durango 187, Col. Roma Norte
Mexico City, CDMX, Mexico 06700
Phone: +52 (55) 8899 1122
RFC: LOGM850312AB1
Dear Ms. López Gutiérrez,
Thank you for visiting our dental practice in Mexico City. Following your comprehensive consultation on June 10, 2025, our team of licensed dentists has prepared this detailed Quotation Estimate outlining the recommended dental treatment plan. This document serves as a formal Quotation Estimate for all procedures discussed during your visit to our clinic located in the heart of Mexico, Mexico City. Please review each line item carefully, as this Quotation Estimate reflects the current pricing structure of our dental services as of the date of issue.
| No. | Dental Service / Procedure | Description | Qty | Unit Price (MXN) | Subtotal (MXN) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral exam, panoramic radiograph, periapical X-rays (4 views), periodontal charting | 1 | $1,850.00 | $1,850.00 |
| 2 | Professional Dental Cleaning (Prophylaxis) | Ultrasonic scaling, air-polishing, fluoride varnish application, oral hygiene instruction | 1 | $1,200.00 | $1,200.00 |
| 3 | Composite Resin Dental Fillings (Class II) | Two-surface restoration on teeth #14 and #24, tooth-colored composite material, bonding agent included | 2 | $2,400.00 | $4,800.00 |
| 4 | Root Canal Treatment (Endodontics) | Single-root canal on tooth #21, includes gutta-percha obturation, temporary restoration, and follow-up visit | 1 | $6,500.00 | $6,500.00 |
| 5 | Ceramic Dental Crown (Zirconia) | Full zirconia crown for tooth #21 post-endodontic treatment, includes temporary crown, impression, and cementation | 1 | $9,800.00 | $9,800.00 |
| 6 | Wisdom Tooth Extraction (Lower Left, Tooth #38) | Surgical extraction of impacted third molar, local anesthesia, sutures, post-operative instructions, and one follow-up visit | 1 | $4,200.00 | $4,200.00 |
| 7 | Professional Teeth Whitening (In-Office) | LED-activated whitening gel, 45-minute session, take-home maintenance kit included | 1 | $3,500.00 | $3,500.00 |
| 8 | Follow-Up Consultations & Adjustments | Three follow-up appointments for healing assessment, crown adjustment, and final evaluation | 3 | $450.00 | $1,350.00 |
Subtotal:$33,200.00 MXN
IVA (16% Tax - SAT Mexico):$5,312.00 MXN
Grand Total:$38,512.00 MXN
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on material costs and exchange rates applicable in Mexico.
- All prices are quoted in Mexican Pesos (MXN) and include the applicable 16% Value Added Tax (IVA) as regulated by the Servicio de Administración Tributaria (SAT) of Mexico.
- Payment may be made in full upon acceptance of this Quotation Estimate, or in up to three (3) equal monthly installments without interest. Accepted payment methods include bank transfer (SPEI), credit/debit card, and cash at our Mexico City office.
- A 50% deposit is required to schedule the first procedure. The remaining balance is due upon completion of the final treatment session.
- This Quotation Estimate does not constitute a binding contract until formally accepted in writing by the client and countersigned by our authorized dental representative.
- All dental procedures will be performed by licensed dentists registered with the Colegio de Odontólogos de la Ciudad de México and in compliance with the General Health Law (Ley General de Salud) of Mexico.
- Any additional procedures identified during treatment that are not included in this Quotation Estimate will be communicated to the client in advance and require separate written authorization before proceeding.
- Our dental practice in Mexico City operates Monday through Friday from 9:00 AM to 7:00 PM and Saturday from 9:00 AM to 2:00 PM. Emergency appointments may be arranged by phone.
- Warranty: All restorative work (crowns, fillings) carries a 12-month warranty against material defects. This warranty does not cover damage caused by trauma, neglect, or failure to attend scheduled follow-up appointments.
- Confidentiality: All patient records and medical information are handled in strict accordance with Mexico's Federal Law on the Protection of Personal Data Held by Private Parties (LFPDPPP).
Lead Dentist & Practice Director
Cédula Profesional: OD-2019-44821
Clínica Dental Sonrisa MX, Mexico City Client Acceptance
Name: ___________________________
Signature: _______________________
Date: ___________________________ ⬇️ Download as DOCX Edit online as DOCX
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