Quotation Estimate Dentist in Senegal Dakar –Free Word Template Download with AI
Professional Dental Services — Senegal Dakar
Document Reference: QE-2025-DAK-0472 | Date of Issue: 15 June 2025
Issued By:Dr. Awa Ndiaye, DDS, MSc
Clinique Dentaire du Lac Rose
12 Boulevard de la Liberté, Plateau
Dakar, Senegal
Tel: +221 33 849 2210
Email: [email protected] Prepared For:
Mr. Ousmane Diop
45 Rue Félix Faure, Médina
Dakar, Senegal
Tel: +221 77 554 8832
Email: [email protected]
This Quotation Estimate has been prepared by our qualified Dentist at Clinique Dentaire du Lac Rose, located in the heart of Senegal Dakar, to provide Mr. Ousmane Diop with a comprehensive and transparent breakdown of the estimated costs associated with a full dental treatment plan. Following a thorough clinical examination conducted on 10 June 2025, our Dentist has identified several areas requiring professional intervention. This document serves as a formal Quotation Estimate outlining all recommended procedures, associated fees, and the conditions under which these services will be delivered in our Senegal Dakar facility.
| Ref. | Dental Procedure / Service | Description | Qty | Unit Price (XOF) | Subtotal (XOF) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral assessment, panoramic radiograph, and periapical X-rays (4 views) | 1 | 45,000 | 45,000 |
| 02 | Professional Dental Scaling & Polishing | Ultrasonic scaling, subgingival debridement, and prophy paste polishing | 1 | 35,000 | 35,000 |
| 03 | Composite Resin Filling (Posterior Teeth) | Multi-surface restoration on teeth #14 and #24 using 3M Z350 composite | 2 | 60,000 | 120,000 |
| 04 | Root Canal Treatment (Single-Root Molar) | Complete endodontic therapy on tooth #36 including obturation and temporary crown | 1 | 180,000 | 180,000 |
| 05 | Porcelain-Fused-to-Metal Crown (PFM) | Custom-fabricated PFM crown for tooth #36, lab work included | 1 | 250,000 | 250,000 |
| 06 | Extraction of Impacted Wisdom Tooth | Surgical extraction of tooth #48 under local anaesthesia with suturing | 1 | 120,000 | 120,000 |
| 07 | Preventive Fluoride Treatment & Sealants | Topical fluoride application and pit-and-fissure sealants on molars | 1 | 25,000 | 25,000 |
| 08 | Follow-Up Consultations (Post-Treatment) | Two scheduled review appointments at 2 weeks and 6 weeks post-procedure | 2 | 15,000 | 30,000 |
| 09 | Prescribed Medication & Aftercare Kit | Antibiotics, analgesics, chlorhexidine mouthwash, and soft-bristle toothbrush | 1 | 18,000 | 18,000 |
| TOTAL ESTIMATED COST (XOF) | 823,000 | ||||
This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. All prices are quoted in West African CFA Francs (XOF) and are inclusive of applicable taxes as per Senegalese regulatory standards. Payment may be arranged in the following manner:
- 50% deposit (411,500 XOF) due upon acceptance of this Quotation Estimate to secure the appointment schedule with our Dentist.
- 50% balance (411,500 XOF) payable upon completion of all procedures and final follow-up consultation.
- Accepted payment methods: bank transfer (BCEAO), mobile money (Orange Money, Wave), cash, or major credit/debit cards. No additional fees apply for electronic transfers within Senegal Dakar.
- Any additional procedures identified during treatment that were not included in this Quotation Estimate will be communicated to the patient in writing before commencement, with a revised estimate provided.
As the treating Dentist, I wish to note that the treatment plan outlined in this Quotation Estimate is designed to address both the immediate concerns identified during the examination and to establish a long-term preventive care strategy. The root canal treatment and subsequent PFM crown on tooth #36 are time-sensitive; delaying this intervention beyond eight weeks may result in periapical infection requiring more extensive surgical intervention. The extraction of the impacted wisdom tooth (#48) is recommended to prevent future pericoronitis and potential damage to the adjacent second molar. All materials used in our Senegal Dakar clinic are CE-certified and sourced through approved medical supply distributors in the region.
Important Note: This Quotation Estimate does not constitute a binding contract. Final costs may vary slightly depending on intra-operative findings. The patient retains the right to accept, decline, or modify any portion of the proposed treatment plan. Our Dentist will discuss all options in detail during the consultation prior to any procedure.By signing below, the patient acknowledges receipt of this Quotation Estimate and authorizes the Dentist at Clinique Dentaire du Lac Rose, Senegal Dakar, to proceed with the dental services as described herein, subject to the terms and conditions stated above.
Patient Signature & DateMr. Ousmane Diop
Dentist / Clinician Signature & DateDr. Awa Ndiaye, DDS, MSc
Clinic Stamp & DateClinique Dentaire du Lac Rose
Senegal Dakar
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