Quotation Estimate Dentist in New Zealand Wellington –Free Word Template Download with AI
142 Cuba Street, Te Aro, Wellington 6011, New Zealand
Phone: +64 4 382 7745 | Email: [email protected]
Healthcare Provider Licence No. NZ-DENT-2019-04872
Quotation EstimateQuotation Details
Quotation No.: WHP-QE-2025-0347
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Sarah Mitchell, Principal Dentist
Client Details
Name: Mr. Jonathan Tui
Address: 8 Khandallah Road, Khandallah, Wellington 6022, New Zealand
Phone: +64 21 456 8892
Email: [email protected]
Health Card No.: 1234 5678 9012
Dear Mr. Tui,
Thank you for visiting our Wellington dental practice for a comprehensive consultation on 10 June 2025. Following a thorough clinical examination, digital radiography, and periodontal assessment conducted by our lead Dentist, Dr. Sarah Mitchell, we are pleased to present this formal Quotation Estimate outlining the recommended course of dental treatment. This Quotation Estimate has been prepared in accordance with the standards set by the Dental Council of New Zealand and reflects the current fee schedule of our practice located in the heart of Wellington, New Zealand.
Please note that this Quotation Estimate is a good-faith projection of costs based on the clinical findings at the time of examination. Should additional procedures become necessary during the course of treatment, a revised Quotation Estimate will be provided and discussed with you prior to any further work being undertaken. All pricing is quoted in New Zealand Dollars (NZD) and includes applicable Goods and Services Tax (GST) at the current rate of 15%.
Itemised Quotation Estimate – Recommended Dental Treatment Plan| Ref | Description of Dental Service | Procedure Code | Est. Hours | Unit Price (NZD) | Quantity | Subtotal (NZD) |
|---|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Digital Panoramic X-Ray (OPG) | DX-101 | 0.5 | $245.00 | 1 | $245.00 |
| 02 | Full Mouth Scaling & Root Planing (4 Quadrants) – Periodontal Therapy | PT-204 | 3.0 | $385.00 | 4 | $1,540.00 |
| 03 | Composite Resin Filling – Tooth 36 (Lower Left First Molar), 2 Surfaces | DR-312 | 1.0 | $420.00 | 1 | $420.00 |
| 04 | Composite Resin Filling – Tooth 14 (Upper Right First Premolar), 1 Surface | DR-311 | 0.75 | $350.00 | 1 | $350.00 |
| 05 | Extraction of Tooth 48 (Lower Right Third Molar) – Surgical, Under Local Anaesthesia | EX-405 | 1.5 | $580.00 | 1 | $580.00 |
| 06 | Porcelain-Fused-to-Metal Crown – Tooth 26 (Upper Left First Molar) | PR-502 | 2.5 | $1,850.00 | 1 | $1,850.00 |
| 07 | Professional Teeth Whitening – In-Office LED System (Single Session) | COS-601 | 1.0 | $495.00 | 1 | $495.00 |
| 08 | Follow-Up Review & Post-Operative Check (Week 2 and Week 6) | RV-701 | 0.5 | $120.00 | 2 | $240.00 |
| 09 | Prescription Medication – Amoxicillin 500mg (14-day course) & Ibuprofen 400mg | PH-801 | — | $38.00 | 1 | $38.00 |
| 10 | Local Anaesthetic & Consumables (included in procedures above) | GEN-900 | — | $0.00 | 1 | $0.00 |
| Subtotal (excl. GST): | $6,358.00 | |||||
| GST @ 15%: | $953.70 | |||||
| TOTAL QUOTATION ESTIMATE (incl. GST): | $7,311.70 | |||||
- This Quotation Estimate is issued by Wellington Harbour Dental Practice, a registered dental provider in New Zealand, and is governed by the Health and Disability Commissioner Act 1994 and the Dental Council of New Zealand Code of Ethics.
- All prices in this Quotation Estimate are in New Zealand Dollars (NZD) and include 15% GST. No additional charges will be applied unless explicitly agreed upon in writing by both parties.
- The Dentist and clinical team at our Wellington practice will use all reasonable endeavours to complete the treatment within the estimated timeframe of 8–10 weeks from the date of acceptance. Delays due to patient availability, material supply, or unforeseen clinical complications may extend this period.
- Payment may be made via EFTPOS, bank transfer, or in up to three interest-free instalments over 90 days. For amounts exceeding NZD $5,000, we offer a 0% interest payment plan over 12 months subject to credit approval.
- Should any procedure require additional work not anticipated at the time of this Quotation Estimate, our Dentist will inform you immediately and provide a supplementary Quotation Estimate before proceeding. No additional work will be performed without your written consent.
- All dental work performed at our New Zealand Wellington practice carries a 12-month warranty on restorative procedures (crowns, fillings, and bridges). This warranty does not cover damage caused by trauma, neglect, or failure to attend scheduled follow-up appointments.
- Client records, radiographs, and treatment plans are stored in accordance with the Privacy Act 2020 (New Zealand). You may request a copy of your records at any time by contacting our practice office.
- This Quotation Estimate does not constitute a contract until signed and returned by the client. Upon acceptance, a formal Treatment Consent Form will be provided for your signature prior to the first procedure.
- Our practice is located at 142 Cuba Street, Te Aro, Wellington, New Zealand, and is easily accessible via public transport (Wellington Railway Station, 5-minute walk) or by car with on-street parking available on Cuba Street.
By signing below, I acknowledge that I have received and reviewed this Quotation Estimate from Wellington Harbour Dental Practice. I understand the recommended treatment plan, the associated costs, and the terms outlined above. I authorise the Dentist and clinical team to proceed with the treatment as described, subject to the payment arrangements agreed upon.
Client Signature: ___________________________
Name: Mr. Jonathan Tui
Date: _______________
Dentist / Practice Representative: ___________________________
Name: Dr. Sarah Mitchell, BDS (Hons), FDSRCS (Edin)
Date: _______________
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