Quotation Estimate Dentist in Netherlands Amsterdam –Free Word Template Download with AI
Prinsengracht 452, 1016 KE Amsterdam, Netherlands
Phone: +31 (0)20 555 0187 | Email: [email protected]
KvK: 67894521 | BTW: NL861234567B01
Quotation EstimateQuotation Estimate Details
Quotation Estimate No.: QTE-2025-0487
Date of Issue: 14 June 2025
Valid Until: 14 July 2025
Prepared By: Dr. Hendrik van der Berg, Lead Dentist
Client Information
Name: [Client Full Name]
Address: [Client Address], Amsterdam, Netherlands
BSN: [Client BSN Number]
Insurance Provider: [Insurance Company]
Policy Number: [Policy Number]
Dear Valued Patient,
Thank you for choosing our practice for your dental care needs. This Quotation Estimate has been carefully prepared by our team of experienced Dentist professionals at our clinic located in the heart of Netherlands Amsterdam. Following your comprehensive consultation and diagnostic examination on 10 June 2025, we are pleased to present this detailed Quotation Estimate outlining the recommended treatment plan, associated costs, and all relevant terms applicable to your care.
Please review this Quotation Estimate thoroughly. As your dedicated Dentist in Netherlands Amsterdam, we are committed to full transparency regarding all procedures, pricing, and expected outcomes. Should you have any questions or require clarification on any item listed in this Quotation Estimate, please do not hesitate to contact our front desk or your assigned Dentist directly.
Scope of Treatment & Itemized CostsThe following Quotation Estimate covers the complete treatment plan as recommended by your treating Dentist. All prices are listed in Euros (EUR) and include the standard 9% VAT applicable to dental services in the Netherlands, unless otherwise noted.
| No. | Procedure / Service | Description | Unit Price (EUR) | Qty | Total (EUR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination | Full oral assessment, intraoral photography, and digital X-rays (panoramic + periapical) performed by the supervising Dentist | € 125.00 | 1 | € 125.00 |
| 2 | Professional Dental Hygiene & Scaling | Ultrasonic scaling, air-polish, and fluoride application. Performed by a registered dental hygienist under Dentist supervision | € 185.00 | 1 | € 185.00 |
| 3 | Composite Tooth-Coloured Filling (Tooth #24) | Removal of caries and placement of aesthetic composite resin restoration. Includes local anaesthesia and post-operative instructions from the Dentist | € 245.00 | 1 | € 245.00 |
| 4 | Root Canal Treatment (Tooth #36) | Endodontic treatment including access cavity preparation, canal instrumentation, obturation, and temporary restoration. Performed by our specialist Dentist in endodontics | € 680.00 | 1 | € 680.00 |
| 5 | Ceramic Crown (Tooth #36) | Full zirconia ceramic crown, including digital impression, laboratory fabrication, and final cementation by the treating Dentist | € 890.00 | 1 | € 890.00 |
| 6 | Wisdom Tooth Extraction (Tooth #48) | Surgical removal of impacted lower right third molar under local anaesthesia. Includes pre-operative consultation with the oral surgeon Dentist and post-operative follow-up | € 420.00 | 1 | € 420.00 |
| 7 | Follow-Up Visit & Adjustment | Post-treatment review, occlusal adjustment, and final assessment by your Dentist. Includes one complimentary recall check within 6 weeks | € 75.00 | 1 | € 75.00 |
| 8 | Emergency / After-Care Consultation | One complimentary telephone or in-person consultation within 14 days of treatment for any post-operative concerns. Provided by the on-call Dentist | € 0.00 | 1 | € 0.00 |
| Subtotal (excl. VAT) | € 2,620.00 | ||||
| VAT (9%) | € 235.80 | ||||
| Grand Total (incl. VAT) | € 2,855.80 | ||||
Note: In the Netherlands, dental services provided by a registered Dentist are subject to a reduced VAT rate of 9%. This Quotation Estimate reflects the current tax regulations as of June 2025. Your health insurance provider may cover a portion of these costs under the basic dental insurance (basisverzekering) or supplementary dental insurance (tandartsverzekering) as per your policy terms in Netherlands Amsterdam.
Insurance & Reimbursement InformationAs a registered practice in Netherlands Amsterdam, we are affiliated with all major Dutch health insurance providers including Zilveren Kruis, VGZ, Menzis, CZ, and OHRA. Upon completion of your treatment, your Dentist will provide a detailed treatment report (tandartsrapport) and itemized invoice to facilitate your insurance claim. Please note that the maximum reimbursement for dental treatments for adults (18+) in the Netherlands is capped at € 250 per year under the basic insurance, with additional coverage available through supplementary policies. This Quotation Estimate is provided for your personal financial planning and does not constitute a guarantee of insurance reimbursement.
Terms & Conditions of This Quotation Estimate- Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, prices may be subject to revision due to changes in material costs, laboratory fees, or regulatory updates in the Netherlands.
- Payment Terms: A deposit of 30% (€ 856.74) is required to confirm your treatment appointment. The remaining balance is due upon completion of the final procedure. We accept bank transfer (iDEAL), credit card (Visa, Mastercard), and direct debit. Payment is due within 14 days of the final invoice.
- Scheduling: The estimated timeline for completing all procedures outlined in this Quotation Estimate is approximately 6 to 8 weeks, depending on laboratory turnaround times for the ceramic crown and healing periods following the wisdom tooth extraction. Your Dentist will coordinate all appointments to minimize inconvenience.
- Cancellations: Appointments cancelled with less than 48 hours' notice will be subject to a fee of € 75.00. Repeated no-shows may result in the practice rescheduling your remaining treatments at a later date.
- Warranty: All restorations (composite filling, ceramic crown) carry a 2-year warranty against material defects. The warranty is void if the restoration is damaged by trauma, bruxism, or neglect of oral hygiene as advised by your Dentist.
- Confidentiality: All patient records, radiographs, and treatment details are handled in strict accordance with the Dutch Medical Treatment Act (Wet medisch treatment) and the General Data Protection Regulation (GDPR) as applicable in the Netherlands.
- Dispute Resolution: Any disputes arising from this Quotation Estimate or the treatment provided shall be resolved in accordance with the Dutch Dental Association (Nederlandse Vereniging van Tandartsen) guidelines and, if necessary, through the competent court in Amsterdam, Netherlands.
By signing below, the patient acknowledges having received and reviewed this Quotation Estimate in full. The patient confirms that the recommended treatment plan has been explained in understandable terms by the treating Dentist, that all questions have been addressed, and that the patient voluntarily consents to proceed with the procedures outlined above. The patient further acknowledges the payment terms, validity period, and all conditions stated in this Quotation Estimate.
Patient Signature & Date[Client Full Name]
Dentist / Practice RepresentativeDr. Hendrik van der Berg
Lead Dentist, Amsterdam Dental Care Centre
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