Quotation Estimate Dentist in Saudi Arabia Jeddah –Free Word Template Download with AI
Professional Dental Services — Jeddah, Saudi Arabia
Ref: QE-JED-2025-04782 Al-Shifa Dental ClinicKing Fahd Road, Al-Salam District
Jeddah 23412, Saudi Arabia
Tel: +966 12 655 4321
Email: [email protected] Quotation Estimate Date: 15 June 2025
Valid Until: 15 July 2025
Prepared For: Mr. Khalid Al-Otaibi
Client ID: CL-2025-1193
Prepared By: Dr. Sarah Al-Harbi, DDS
This Quotation Estimate has been prepared by Al-Shifa Dental Clinic, a licensed and accredited Dentist practice operating in Jeddah, Saudi Arabia, to provide Mr. Khalid Al-Otaibi with a comprehensive and transparent breakdown of the anticipated costs for the recommended dental treatment plan. As a Dentist committed to the highest standards of patient care in the Kingdom of Saudi Arabia, our clinic in Jeddah ensures that every Quotation Estimate reflects accurate pricing, compliant with the regulations set forth by the Saudi Food and Drug Authority (SFDA) and the Ministry of Health. This document serves as a formal Quotation Estimate and does not constitute a binding contract until accepted in writing by the client.
Following a thorough clinical examination conducted at our Dentist facility in Jeddah, Saudi Arabia, the following procedures have been recommended. Each line item in this Quotation Estimate represents a specific dental service to be performed by our qualified Dentist team:
| # | Dental Procedure / Service | Description | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Rays | Full oral assessment, panoramic and periapical radiographs | 1 | 450.00 | 450.00 |
| 2 | Professional Dental Scaling & Polishing | Ultrasonic scaling, air-polishing, and fluoride application | 1 | 650.00 | 650.00 |
| 3 | Composite Resin Dental Fillings (Posterior) | Two-surface composite restoration, teeth #14 and #24 | 2 | 850.00 | 1,700.00 |
| Root Canal Treatment (Single-Root Molar) | Endodontic therapy on tooth #36 with gutta-percha obturation | 1 | 3,200.00 | 3,200.00 | |
| 5 | Full-Ceramic Crown (Zirconia) | Custom zirconia crown for tooth #36, lab-fabricated in Jeddah | 1 | 4,500.00 | 4,500.00 |
| 6 | Orthodontic Consultation & Digital Impression | Initial orthodontic assessment with 3D intraoral scanning | 1 | 750.00 | 750.00 |
| 7 | Emergency Dental Kit & Aftercare Package | Take-home kit, post-operative medications, and follow-up visits | 1 | 350.00 | 350.00 |
| Subtotal (SAR) | 11,600.00 | ||||
| VAT @ 15% (Saudi Arabia) | 1,740.00 | ||||
| Grand Total (SAR) | 13,340.00 | ||||
All prices are quoted in Saudi Riyals (SAR). The 15% Value Added Tax (VAT) is applied in accordance with the General Authority of Zakat and Tax (GAZT) regulations in Saudi Arabia.
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision based on material costs and exchange rates applicable in Jeddah, Saudi Arabia.
- Payment Terms: A 50% deposit is required to schedule the first appointment at our Dentist clinic. The remaining balance is due upon completion of all procedures. Payment may be made via bank transfer, credit card, or cash at our Jeddah facility.
- Insurance: This Quotation Estimate may be submitted to your health insurance provider for pre-authorization. Al-Shifa Dental Clinic is registered with all major insurance companies operating in Saudi Arabia, including Bupa, Tawuniya, and MedGulf.
- Scheduling: Appointments at our Dentist practice in Jeddah are available Monday through Saturday, 9:00 AM to 9:00 PM. Emergency dental services are available on a 24/7 basis.
- Warranty: All dental restorations and crowns included in this Quotation Estimate carry a minimum two-year warranty against manufacturing defects, as per Saudi Arabian consumer protection standards.
- Regulatory Compliance: All procedures are performed in strict compliance with the Saudi Ministry of Health guidelines and the SFDA regulations governing dental materials and practices in Jeddah and the wider Kingdom of Saudi Arabia.
- Confidentiality: All patient records and the contents of this Quotation Estimate are treated with the utmost confidentiality in accordance with Saudi data protection laws.
By signing below, the client acknowledges receipt of this Quotation Estimate for dental services at Al-Shifa Dental Clinic in Jeddah, Saudi Arabia, and agrees to the terms and conditions outlined herein. This signature authorizes the Dentist team to proceed with the recommended treatment plan as described in this document.
Client SignatureMr. Khalid Al-Otaibi
Date: _______________ Authorized Dentist Representative
Dr. Sarah Al-Harbi, DDS
Al-Shifa Dental Clinic, Jeddah
Date: _______________
© 2025 Al-Shifa Dental Clinic — Jeddah, Saudi Arabia — CR: 1010XXXXXX — MHLB License: 4020XXXXXX
This Quotation Estimate is a formal document issued by a licensed Dentist practice in Jeddah, Saudi Arabia.
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