Quotation Estimate Dentist in Philippines Manila –Free Word Template Download with AI
Unit 1208, Ayala Avenue Tower, Makati City, Metro Manila, Philippines 1226
Tel: +63 (2) 8888-4521 | Email: [email protected]
PRC License No. 2019-04521 | DOH Accredited Facility
Quotation EstimateQuotation Details
Quotation No.: MDC-2025-0718-0042
Date Issued: July 18, 2025
Valid Until: August 17, 2025 (30 days)
Prepared By: Dr. Maria Santos, DDS, MS
Location: Makati City, Metro Manila, Philippines
Client Information
Name: Mr. Juan Dela Cruz
Address: 45 Bonifacio Street, BGC, Taguig City, Philippines
Contact: +63 917 555 0123
Email: [email protected]
TIN: 123-456-789-000
Dear Mr. Dela Cruz,
Thank you for choosing Manila Dental Care Center for your dental health needs. As a leading Dentist practice based in the vibrant city of Philippines Manila, we are committed to providing world-class dental care tailored to the unique needs of our patients in the Metro Manila region. This Quotation Estimate outlines the comprehensive dental treatment plan recommended following your initial consultation and diagnostic imaging on July 15, 2025. All prices are quoted in Philippine Pesos (PHP) and are subject to the terms and conditions stated herein.
| No. | Dental Service / Procedure | Description | Qty | Unit Price (PHP) | Amount (PHP) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Consultation | Full oral assessment, intraoral photography, and treatment planning by a licensed Dentist in Manila | 1 | 1,500.00 | 1,500.00 |
| 2 | Full-Mouth Digital X-Ray (Panoramic & Periapical) | Advanced digital radiography for complete diagnostic evaluation | 1 | 2,200.00 | 2,200.00 |
| 3 | Professional Dental Cleaning (Scaling & Polishing) | Ultrasonic scaling, air polishing, and fluoride application | 2 | 3,500.00 | 7,000.00 |
| 4 | Composite Resin Filling (Posterior Teeth) | TOOTHLESS composite restoration for molars, including etching, bonding, and polishing | 3 | 4,500.00 | 13,500.00 |
| 5 | Root Canal Treatment (Single-Rooted Tooth) | Complete endodontic therapy including obturation and temporary restoration | 1 | 12,000.00 | 12,000.00 |
| 6 | Porcelain Crown (Zirconia) | Custom-fabricated zirconia crown, including impression, try-in, and cementation | 1 | 18,500.00 | 18,500.00 |
| 7 | Extraction of Impacted Wisdom Tooth (Lower) | Surgical extraction under local anesthesia with suturing and post-operative care | 1 | 8,000.00 | 8,000.00 |
| 8 | Teeth Whitening (In-Office LED System) | Professional in-office whitening treatment using hydrogen peroxide gel and LED light | 1 | 6,500.00 | 6,500.00 |
| 9 | Follow-Up Consultation & Post-Operative Check | Two follow-up visits for healing assessment and adjustment | 2 | 800.00 | 1,600.00 |
| 10 | Medication & Post-Operative Supplies | Antibiotics, analgesics, chlorhexidine mouthwash, and healing gel | 1 | 1,200.00 | 1,200.00 |
| Subtotal | 72,000.00 | ||||
| VAT (12%) | 8,640.00 | ||||
| TOTAL AMOUNT DUE (PHP) | 80,640.00 | ||||
Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After this period, prices may be adjusted to reflect current market rates for dental materials and services in the Philippines Manila area.
- All dental procedures will be performed by a licensed and board-certified Dentist registered with the Philippine Board of Dentistry and the Professional Regulation Commission (PRC) of the Philippines.
- Payment terms: Fifty percent (50%) down payment is required upon acceptance of this Quotation Estimate. The remaining balance shall be settled upon completion of all scheduled procedures.
- Accepted payment methods include cash, bank transfer (BDO, BPI, Metrobank), credit/debit cards (Visa, Mastercard), and GCash. A 2% convenience fee applies to online payments.
- All dental work is covered under our clinic's quality assurance policy. In the unlikely event of a procedural complication, a complimentary re-treatment will be provided within ninety (90) days.
- Manila Dental Care Center operates in compliance with all regulations set by the Department of Health (DOH) of the Philippines and the Philippine Dental Association (PDA).
- This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. Individual results may vary based on patient anatomy, healing response, and compliance with post-operative instructions.
- Any additional procedures identified during treatment that are not included in this estimate will be discussed with the patient and a supplementary Quotation Estimate will be issued prior to commencement.
- Cancellation or rescheduling of appointments must be made at least forty-eight (48) hours in advance. Late cancellations may incur a 20% fee of the scheduled procedure cost.
- This document is issued by Manila Dental Care Center, a registered dental practice located in Metro Manila, Philippines, and is governed by the laws of the Republic of the Philippines.
Prepared and Certified By:
Dr. Maria Santos, DDS, MSLead Dentist, Manila Dental Care Center
PRC License No. 2019-04521
Accepted By (Client):
Mr. Juan Dela CruzDate: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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