Quotation Estimate Dentist in Saudi Arabia Riyadh –Free Word Template Download with AI
Professional Dentist Services | Riyadh, Saudi Arabia
Al Olaya District, King Fahd Road, Riyadh 12212, Saudi Arabia
Phone: +966 11 456 7890 | Email: [email protected]
Ministry of Health License No. MOH-2024-008765 | CR: 1010456789
Quotation Estimate No.: QE-RYD-2025-0347Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days) Prepared By: Dr. Khalid Al-Rashid, DDS
Specialty: General & Cosmetic Dentistry
Location: Riyadh, Saudi Arabia Client / Patient Information
| Patient Name: | Mr. Ahmed Mohammed Al-Saud | National ID / Iqama No.: | 1045678901 |
| Contact Number: | +966 55 123 4567 | Email: | [email protected] |
| Address: | Al Malqa District, Riyadh, Saudi Arabia | ||
The following Quotation Estimate has been prepared by our qualified Dentist team at Riyadh Dental Excellence Center, Riyadh, Saudi Arabia, following a comprehensive clinical examination and diagnostic imaging (intraoral X-rays and panoramic radiograph) conducted on 12 June 2025. All prices are quoted in Saudi Riyals (SAR) and are inclusive of applicable Value Added Tax (VAT) at 15% as mandated by the Zakat, Tax and Customs Authority (ZATCA) of Saudi Arabia.
| # | Dental Procedure / Service | Description & Clinical Notes | Qty | Unit Price (SAR) |
|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Consultation | Full oral assessment by the lead Dentist, including periodontal charting, occlusal analysis, and treatment planning session in Riyadh, Saudi Arabia. | 1 | 350.00 |
| 2 | Digital Panoramic & Periapical X-Rays | Full-mouth digital radiographic imaging (12 periapical views + 1 panoramic) for diagnostic purposes, performed at our Riyadh clinic facility. | 1 | 450.00 |
| 3 | Ultrasonic Scaling & Polishing (Full Mouth) | Professional prophylaxis including ultrasonic subgingival scaling, air-polishing, and fluoride varnish application to remove calculus and plaque buildup. | 1 | 600.00 |
| 4 | Composite Resin Restorations (Anterior & Posterior) | Placement of tooth-colored composite fillings on teeth #11, #21, #36, and #46. Includes local anesthesia, etching, bonding, and polishing. Performed by the treating Dentist in Riyadh, Saudi Arabia. | 4 | 550.00 |
| 5 | Root Canal Treatment (Single-Root Molar) | Complete endodontic treatment on tooth #36 including access cavity preparation, canal instrumentation, obturation with gutta-percha, and temporary restoration. Follow-up permanent crown to be quoted separately. | 1 | 2,800.00 |
| 6 | Ceramic (Zirconia) Crown – Tooth #36 | Fabrication and cementation of a full zirconia ceramic crown following root canal completion. Includes digital impression, laboratory fabrication, and final seating by the Dentist. | 1 | 3,500.00 |
| 7 | Teeth Whitening (In-Office LED System) | Single-session professional whitening using hydrogen peroxide gel with LED light activation. Performed under the supervision of the Dentist at our Riyadh, Saudi Arabia clinic. | 1 | 1,200.00 |
| 8 | Follow-Up Visits & Post-Operative Care | Two (2) follow-up appointments within 30 days for post-operative assessment, suture check (if applicable), and adjustment of restorations as needed. | 2 | 150.00 |
| Subtotal (Excluding VAT): | 12,350.00 SAR | |||
| VAT (15%): | 1,852.50 SAR | |||
| TOTAL QUOTATION ESTIMATE AMOUNT: | 14,202.50 SAR | |||
- This Quotation Estimate is a non-binding estimate of costs and does not constitute a final invoice. A formal invoice will be issued upon the patient's written acceptance of the proposed treatment plan.
- All dental treatments listed in this Quotation Estimate will be carried out at the Riyadh Dental Excellence Center, located in Riyadh, Saudi Arabia, in full compliance with the regulations set forth by the Saudi Ministry of Health and the Saudi Food and Drug Authority (SFDA).
- The treating Dentist reserves the right to modify the treatment plan should additional clinical findings emerge during the course of procedures. Any such modifications will be communicated to the patient in writing prior to execution, and a revised Quotation Estimate will be provided.
- Payment terms: 50% deposit is required at the time of accepting this Quotation Estimate to secure the appointment slot. The remaining 50% balance is due upon completion of all scheduled procedures. Payment may be made via bank transfer, credit/debit card, or cash at our Riyadh, Saudi Arabia office.
- A warranty period of 12 months applies to all restorative work (crowns, fillings, and root canal treatments) as per the standard warranty policy of the clinic in Riyadh, Saudi Arabia. The warranty covers material defects and does not cover damage resulting from patient negligence or trauma.
- All patient records, radiographic images, and treatment documentation will be maintained in accordance with the Saudi Personal Data Protection Law (PDPL) and the Ministry of Health data retention guidelines.
- This Quotation Estimate does not include emergency dental services, hospitalization, or any procedures not explicitly listed above. Additional services will be quoted separately.
- In the event of cancellation by the patient, the 50% deposit is non-refundable if cancellation occurs less than 48 hours before the scheduled appointment date.
- All prices are quoted in Saudi Riyals (SAR). For international patients, currency conversion will be at the prevailing rate on the date of payment.
- This Quotation Estimate is governed by the laws of the Kingdom of Saudi Arabia. Any disputes arising from this document shall be subject to the jurisdiction of the courts in Riyadh, Saudi Arabia.
By signing below, the patient acknowledges receipt of this Quotation Estimate for dental services in Riyadh, Saudi Arabia, and agrees to the terms and conditions outlined above. The patient confirms that the treating Dentist has explained the proposed treatment plan, associated risks, and alternative options in a clear and understandable manner.
Patient SignatureName: Mr. Ahmed Mohammed Al-Saud
Date: _______________
Dr. Khalid Al-Rashid, DDS
Riyadh Dental Excellence Center
Date: _______________
Riyadh, Saudi Arabia
License No. MOH-2024-008765
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