Quotation Estimate Dentist in Russia Moscow –Free Word Template Download with AI

Service Provider (Dentist)

Capital Dental Clinic Moscow

12 Tverskaya Street, Building 3

Moscow, 125009, Russia

Tel: +7 (495) 123-45-67

Email: [email protected]

INN: 7701234567

Client / Patient

Mr. Alexander Petrov

45 Arbat Street, Apt. 12

Moscow, 119019, Russia

Tel: +7 (916) 555-88-99

Email: [email protected]

Passport No: 45 1234567

Quotation Date: 15 June 2025 Valid Until: 15 July 2025 (30 days) Currency: Russian Rubles (RUB / &rub;) Prepared By: Dr. Elena Sokolova, Chief Dentist

This Quotation Estimate is issued by Capital Dental Clinic Moscow, a licensed Dentist practice operating in Russia Moscow, to provide Mr. Alexander Petrov with a comprehensive and transparent breakdown of all anticipated costs associated with the proposed dental treatment plan. This document serves as a formal Quotation Estimate for the full scope of Dentist services to be rendered at our clinic located in the heart of Russia Moscow. All pricing reflects current market rates applicable to Dentist procedures in Russia Moscow as of the date of issue.

Following a comprehensive diagnostic examination conducted on 10 June 2025, our senior Dentist team has recommended the following treatment plan. Each item below represents a specific Dentist procedure to be performed at our Russia Moscow facility:

No.	Dentist Procedure / Service	Description	Qty	Unit Price (RUB)	Total (RUB)
1	Full Oral Diagnostic Examination	Complete intraoral examination, panoramic X-ray (OPG), and digital periapical radiographs (8 views) performed by the lead Dentist in Russia Moscow.	1	4,500	4,500
2	Professional Dental Hygiene & Scaling	Ultrasonic scaling, air-polishing, and fluoride application. Standard Dentist preventive care procedure.	1	6,800	6,800
3	Composite Resin Restorations (Class II)	Placement of aesthetic composite fillings on molars #16 and #26. Performed by a certified Dentist specialist.	2	12,500	25,000
4	Root Canal Treatment (Endodontics)	Complete endodontic treatment of tooth #36 (mandibular molar, 3 canals) including obturation and temporary restoration.	1	28,000	28,000
5	Ceramic Crown (Zirconia) — Tooth #36	Design and fabrication of a full zirconia ceramic crown, including digital impression (intraoral scanner), try-in, and final cementation by the Dentist.	1	35,000	35,000
6	Extraction of Tooth #48 (Wisdom Tooth)	Surgical extraction of impacted mandibular third molar under local anesthesia. Performed by an oral surgeon / Dentist.	1	18,500	18,500
7	Post-Operative Follow-Up Visits	Two (2) control appointments at 7 days and 30 days post-treatment for suture removal, healing assessment, and final adjustment. Included in the Dentist care package.	2	1,500	3,000
8	Prescription Medications & Materials	Antibiotics, analgesics, antiseptic mouthwash, and post-operative care kit as prescribed by the treating Dentist.	1	3,200	3,200
Subtotal:					124,000
VAT (20% — Russia Moscow tax rate):					24,800
TOTAL ESTIMATED COST:					148,800 RUB

3.1 Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Dentist clinic in Russia Moscow reserves the right to revise pricing due to changes in material costs, exchange rates, or regulatory adjustments within Russia Moscow.

3.2 Payment Schedule: A deposit of 30% (44,640 RUB) is required to confirm the appointment and secure the Dentist's schedule. The remaining 70% (104,160 RUB) shall be paid upon completion of all procedures. Payment may be made in Russian Rubles via bank transfer, cash, or major credit/debit cards accepted at our Russia Moscow location.

3.3 Treatment Timeline: The full Dentist treatment plan is expected to be completed within 4 to 6 weeks, subject to the patient's availability and the healing period required for the zirconia crown fabrication. All appointments will be scheduled at our clinic in central Russia Moscow.

3.4 Cancellation Policy: Cancellations must be made at least 48 hours in advance. Late cancellations or no-shows will incur a fee of 50% of the scheduled Dentist procedure cost.

3.5 Warranty: All Dentist restorations (composite fillings, zirconia crown) carry a warranty of 24 months from the date of final cementation, provided the patient adheres to the aftercare instructions issued by the treating Dentist in Russia Moscow.

3.6 Regulatory Compliance: All procedures are performed in full compliance with the Federal Law of the Russian Federation on Healthcare (No. 323-FZ) and the licensing requirements for Dentist practices in Russia Moscow. Our clinic holds License No. ЛО-77-01-003456 issued by the Moscow City Health Department.

3.7 Data Protection: Patient medical records and personal data are handled in accordance with Federal Law No. 152-FZ on Personal Data. All information is stored securely within Russia Moscow and is not transferred to third parties without written consent.

Note: This Quotation Estimate is a good-faith projection of costs. In the unlikely event that additional Dentist procedures are identified during treatment (e.g., unexpected complications during root canal therapy or extraction), a supplementary Quotation Estimate will be issued and must be approved in writing by the patient before any additional work is performed. All such adjustments will be communicated transparently by the treating Dentist at our Russia Moscow clinic.

By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed Dentist treatment plan, and authorizes Capital Dental Clinic Moscow to proceed with the services described herein at the rates specified. This signature constitutes acceptance of all terms and conditions outlined in this document.

For Capital Dental Clinic Moscow (Dentist Provider)

Dr. Elena Sokolova
Chief Dentist / Medical Director
Date: _______________

Patient / Client

Mr. Alexander Petrov
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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