Quotation Estimate Dentist in Singapore Singapore –Free Word Template Download with AI
Professional Dental Services — Singapore Singapore
Ref: QE-2025-SG-04872 | Valid for 30 days from date of issue
Date of Issue: 15 June 2025Quotation Estimate No.: QE-2025-SG-04872
Prepared By: Dr. Lim Wei Jian, DDS Practice: Singapore Singapore Dental Clinic
Address: 128 Orchard Road, #05-12, Singapore Singapore 238849
Contact: +65 6842 3300 | [email protected] 1. Client / Patient Information
Patient Details
Patient Name: Mr. Tan Kah Seng
NRIC / Passport No.: S89XXXXXXX(A)
Address: 45 Bukit Timah Road, #12-08, Singapore Singapore 269692
Contact Number: +65 9123 4567
Email: [email protected]
Insurance Provider: Prudential Singapore (Policy No. PRU-2024-88712)
This Quotation Estimate has been prepared by our Dentist team at Singapore Singapore Dental Clinic following a comprehensive clinical examination conducted on 10 June 2025. The Dentist, Dr. Lim Wei Jian, has assessed the patient's oral health and identified the following required treatments. All pricing in this Quotation Estimate reflects the standard rates applicable in Singapore Singapore for the 2025 fiscal year and are quoted in Singapore Dollars (SGD).
| No. | Dental Procedure / Service | Description & Clinical Notes | Qty | Unit Price (SGD) | Amount (SGD) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral examination, panoramic radiograph (OPG), and periapical X-rays (4 views) by the Dentist | 1 | SGD 285.00 | SGD 285.00 |
| 2 | Ultrasonic Scaling & Polishing (Prophy) | Full-mouth supragingival and subgingival scaling using ultrasonic scaler, followed by professional polishing | 1 | SGD 320.00 | SGD 320.00 |
| 3 | Composite Resin Fillings (Tooth #24 & #46) | Removal of carious tissue and restoration with aesthetic composite resin material (3M Z350 XT) on two molars | 2 | SGD 380.00 | SGD 760.00 |
| 4 | Root Canal Treatment (Tooth #11) — Single Visit | Endodontic treatment of maxillary central incisor including access cavity preparation, canal instrumentation, obturation, and temporary restoration | 1 | SGD 1,450.00 | SGD 1,450.00 |
| 5 | Porcelain Crown (Tooth #11) — E.max CAD/CAM | Full-coverage ceramic crown fabricated in-house using CAD/CAM technology, including try-in and final cementation | 1 | SGD 1,850.00 | SGD 1,850.00 |
| 6 | Extraction of Wisdom Tooth (Tooth #48) — Surgical | Removal of partially impacted mandibular third molar under local anaesthesia, including suturing and post-operative instructions | 1 | SGD 680.00 | SGD 680.00 |
| 7 | Fluoride Varnish Application | Topical fluoride varnish (5% sodium fluoride) applied to all teeth for cavity prevention | 1 | SGD 95.00 | SGD 95.00 |
| 8 | Follow-Up Consultation & Post-Operative Review | Two follow-up visits (2 weeks and 6 weeks post-treatment) with the Dentist for healing assessment and adjustment | 2 | SGD 120.00 | SGD 240.00 |
| 9 | Prescription Medication & Post-Extraction Kit | Antibiotics (Amoxicillin 500mg x10), analgesics, and post-extraction care kit (ice pack, gauze, saline rinse) | 1 | SGD 65.00 | SGD 65.00 |
| Subtotal | SGD 5,745.00 | ||||
| GST @ 9% (Singapore Singapore) | SGD 517.05 | ||||
| TOTAL QUOTATION ESTIMATE AMOUNT | SGD 6,262.05 | ||||
- This Quotation Estimate is a good-faith estimate of costs and does not constitute a binding contract until accepted in writing by the patient and countersigned by the Dentist at Singapore Singapore Dental Clinic.
- Payment is due in full within 14 days of the completion of all dental procedures outlined in this Quotation Estimate. Accepted payment methods include bank transfer, credit/debit card (Visa, Mastercard, AMEX), and PayNow (Singapore Singapore).
- A 50% deposit is required to schedule the surgical extraction and root canal treatment appointments. The remaining balance is payable upon completion of the respective procedure.
- Insurance claims: The patient is responsible for submitting all insurance claims to their respective provider. Our practice in Singapore Singapore will provide itemised invoices and clinical reports as required by the insurer. The Dentist will assist with pre-authorization documentation where applicable.
- Warranty: All restorative work (composite fillings, porcelain crown) carries a 12-month warranty against material defects. The warranty does not cover damage caused by trauma, bruxism, or failure to attend scheduled follow-up appointments.
- Cancellation: Appointments cancelled with less than 48 hours' notice will incur a fee of SGD 100. No-shows will be charged the full consultation fee of SGD 150.
- All personal health data is handled in strict compliance with the Personal Data Protection Act (PDPA) of Singapore Singapore. Patient records are stored securely and will not be disclosed to third parties without written consent.
- This Quotation Estimate is governed by the laws of Singapore Singapore. Any disputes arising from the services described herein shall be subject to the exclusive jurisdiction of the courts of Singapore Singapore.
By signing below, the patient acknowledges that this Quotation Estimate has been explained in full by the Dentist, Dr. Lim Wei Jian, and that the patient consents to the proposed dental treatment plan as outlined above. The patient confirms understanding of the risks, benefits, and alternative treatments discussed during the consultation at our Singapore Singapore clinic.
Patient SignatureMr. Tan Kah Seng
Date: _______________ Dentist / Authorising Practitioner
Dr. Lim Wei Jian, DDS
Singapore Singapore Dental Clinic
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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