Quotation Estimate Dentist in Nepal Kathmandu –Free Word Template Download with AI
Comprehensive Dental Treatment Plan & Cost Estimate
Prepared for: Nepal Kathmandu Region
From: The Clinic
Kathmandu Smile Dental Clinic
Boudha Road, Ward No. 10
Kathmandu, Nepal – 44600
Phone: +977-1-4412345
Email: [email protected]
License No: NMDA-2024-0871
Quotation Details
Quotation No: QTE-2025-0412
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Currency: Nepalese Rupees (NPR)
Prepared By: Dr. Anisha Shrestha, BDS, MDS
To: The Patient
Name: Mr. Rajesh Koirala
Address: New Baneshwor, Kathmandu, Nepal
Phone: +977-9841234567
Pan No: 12345678-9
Referral Source: Walk-in Patient
Consultation Summary
Chief Complaint: Severe tooth pain (tooth #14), missing molar (tooth #36), general gum inflammation, and cosmetic concern regarding anterior teeth alignment.
Diagnosis: Deep caries, edentulous site, chronic periodontitis, mild malocclusion.
This Quotation Estimate has been carefully prepared by our experienced Dentist team at Kathmandu Smile Dental Clinic, located in the heart of Nepal Kathmandu. The following line items represent the complete scope of recommended dental procedures, diagnostic work, and follow-up care. All prices are quoted in Nepalese Rupees (NPR) and include applicable materials, labor, and standard aftercare within the validity period of this estimate.
| S.No | Procedure / Service | Description | Qty | Unit Price (NPR) | Total (NPR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Ray (OPG + Periapical) | Full oral assessment, panoramic radiograph, and targeted periapical images for treatment planning. | 1 | 2,500 | 2,500 |
| 2 | Scaling & Root Planing (Full Mouth) | Ultrasonic and manual scaling with root planing to treat chronic periodontitis. Includes post-procedure oral hygiene instruction. | 1 | 6,000 | 6,000 |
| 3 | Root Canal Treatment – Tooth #14 (Upper Left First Molar) | Three-canal RCT using rotary endodontic instruments, gutta-percha obturation, and temporary restoration. Final crown to be placed separately. | 1 | 12,000 | 12,000 |
| 4 | Full Ceramic Crown – Tooth #14 | High-strength zirconia ceramic crown, CAD/CAM milled, cemented with resin-modified glass ionomer. Includes two appointments. | 1 | 18,500 | 18,500 |
| 5 | Dental Implant – Tooth #36 (Lower Right First Molar) | Titanium endosseous implant (4.0mm x 13mm), healing abutment, and 3-month osseointegration period. Includes surgical guide and post-op medications. | 1 | 55,000 | 55,000 |
| 6 | Implant-Supported Ceramic Crown – Tooth #36 | Custom zirconia crown on implant abutment, shade-matched to adjacent dentition. Includes abutment screw and final cementation. | 1 | 22,000 | 22,000 |
| 7 | Professional Teeth Whitening (In-Office, LED System) | Single-visit in-office whitening using 35% hydrogen peroxide gel with LED activation. Includes take-home maintenance kit. | 1 | 8,000 | 8,000 |
| 8 | Composite Veneers – Teeth #11, #12, #21, #22 (Anterior) | Direct composite resin veneers for aesthetic correction of mild malocclusion and enamel defects. Includes shade selection and polishing. | 4 | 5,500 | 22,000 |
| 9 | Follow-Up Visits & Post-Operative Care (3 Months) | Three scheduled follow-up appointments for implant site monitoring, crown adjustment, and periodontal re-evaluation. Includes one complimentary recall cleaning. | 3 | 1,500 | 4,500 |
| 10 | Emergency Dental Care Package (12 Months) | Unlimited emergency consultations, temporary restorations, and pain management within 12 months of this Quotation Estimate date. | 1 | 3,000 | 3,000 |
| Subtotal | 153,500 | ||||
| VAT (13% as per Nepal Inland Revenue) | 19,955 | ||||
| Grand Total (NPR) | 173,455 | ||||
| Milestone | Due Date | Amount (NPR) |
|---|---|---|
| Advance (upon acceptance of this Quotation Estimate) | Within 7 days | 52,037 (30%) |
| Second Installment (before implant surgery) | 4 weeks from start | 52,037 (30%) |
| Final Payment (upon completion of all procedures) | Within 3 months | 69,381 (40%) |
Terms & Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After the expiry date, prices may be revised due to changes in material costs, import duties, or exchange rate fluctuations affecting dental supplies in Nepal Kathmandu.
- All dental procedures listed herein will be performed by a qualified and licensed Dentist or dental specialist registered with the Nepal Medical Council and the Kathmandu Valley Dental Association.
- The implant warranty is valid for five (5) years from the date of final crown placement, provided the patient adheres to all post-operative care instructions and attends scheduled follow-up visits at our Nepal Kathmandu clinic.
- Any additional procedures identified during the course of treatment (e.g., unexpected bone grafting, additional restorations) will be communicated to the patient in writing before commencement, and a supplementary Quotation Estimate will be issued.
- Payment may be made via cash, bank transfer (Nabil Bank, NMB Bank, or Global IME Bank), or major credit/debit cards accepted at our Kathmandu clinic. A 2% convenience fee applies to card transactions.
- This Quotation Estimate does not include hospitalization charges, general anesthesia fees, or costs related to pre-existing medical conditions that may require additional specialist consultation.
- The patient agrees to a 48-hour cancellation policy for scheduled appointments. Cancellations made within 48 hours will incur a fee of NPR 2,000 per appointment.
- All diagnostic records, radiographs, and treatment plans generated under this Quotation Estimate remain the property of Kathmandu Smile Dental Clinic. The patient is entitled to a copy upon request.
- This document is governed by the laws of the Kingdom of Nepal. Any disputes arising from this Quotation Estimate shall be resolved through the Kathmandu District Court or by mutual arbitration as per Nepal's Consumer Protection Act, 2075.
Dr. Anisha Shrestha, BDS, MDS
Lead Dentist & Clinician
Kathmandu Smile Dental Clinic
Date: _______________
Mr. Rajesh Koirala
Patient / Authorized Signatory
Date: _______________
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