Quotation Estimate Dentist in South Africa Cape Town –Free Word Template Download with AI
Professional Dental Services — Dentist Practice, South Africa Cape Town
Dental Practice Details
Cape Town Dental & Implant Centre
142 Sea Point Promenade, Sea Point
Cape Town, 8005, Western Cape
South Africa
Tel: +27 21 424 7890
Email: [email protected]
HPCSA Reg. No: 0012345678
Client Details
Mr. James van der Merwe
28 Kloof Road, Claremont
Cape Town, 7708, Western Cape
South Africa
Tel: +27 82 555 0147
Email: [email protected]
Medical Aid: Discovery Health
Member No: DH-44829103
Dear Mr. van der Merwe,
Thank you for choosing Cape Town Dental & Implant Centre for your oral healthcare needs. This Quotation Estimate has been prepared following your comprehensive dental consultation conducted on 10 June 2025 at our Sea Point practice in South Africa Cape Town. As your dedicated Dentist, I have outlined below the full scope of recommended treatment, itemised costs, and applicable medical aid contributions. Please review this Quotation Estimate carefully and do not hesitate to contact our practice for any clarifications regarding the proposed dental procedures.
Itemised Treatment Plan & Costs| Ref | Dental Procedure / Service | Code | Qty | Unit Price (ZAR) | Amount (ZAR) |
|---|---|---|---|---|---|
| 01 | Comprehensive Oral Examination & Digital X-Rays (Panoramic + Periapical) | DA0150 | 1 | R 850.00 | R 850.00 |
| 02 | Ultrasonic & Hand Scaling with Polishing (Full Mouth) | DA1110 | 1 | R 1 250.00 | R 1 250.00 |
| 03 | Root Canal Treatment — Upper Right Molar (Tooth 16), 3 Canals | DA2151 | 1 | R 4 800.00 | R 4 800.00 |
| 04 | Full-Ceramic Crown (Zirconia) — Upper Right Molar (Tooth 16) | DA2740 | 1 | R 6 500.00 | R 6 500.00 |
| 05 | Composite Resin Filling — Lower Left Premolar (Tooth 34), 2 Surfaces | DA2392 | 1 | R 1 450.00 | R 1 450.00 |
| 06 | Extraction — Upper Left Wisdom Tooth (Tooth 28), Surgical | DA7480 | 1 | R 3 200.00 | R 3 200.00 |
| 07 | Prophylaxis & Fluoride Varnish Application (Post-Treatment) | DA1110 | 1 | R 650.00 | R 650.00 |
| 08 | Follow-Up Consultation & Suture Removal (2 weeks post-extraction) | DA0010 | 1 | R 450.00 | R 450.00 |
| Subtotal (Excl. VAT) | R 19 150.00 |
| VAT @ 15% (South Africa) | R 2 872.50 |
| Medical Aid Contribution (Discovery Health) | (R 12 400.00) |
| Balance Payable by Client | R 9 622.50 |
- This Quotation Estimate is valid for a period of thirty (30) days from the date of issue. After this period, prices may be adjusted to reflect current market rates for dental materials and professional services in South Africa Cape Town.
- All fees are quoted in South African Rand (ZAR) and are inclusive of the standard 15% Value Added Tax (VAT) as prescribed by the South African Revenue Service (SARS).
- The medical aid contribution indicated is an estimate based on your current Discovery Health plan benefits. The final reimbursement amount is subject to the terms of your specific medical aid scheme and may vary. Our practice in South Africa Cape Town is a registered provider with Discovery Health, and we will submit all claims on your behalf.
- Payment of the client balance is due within fourteen (14) days of the completion of all dental procedures. We accept EFT, credit/debit card, and cash. A 10% deposit is required to schedule the surgical extraction and root canal treatment.
- As your treating Dentist, I will personally oversee all procedures outlined in this Quotation Estimate. The surgical extraction of the wisdom tooth will be performed under local anaesthesia with sedation available upon request at an additional cost of R 800.00.
- The zirconia crown will be fabricated by our in-house dental laboratory in Sea Point, Cape Town, and requires two appointments: one for the impression and temporary crown, and a second for the final fitting approximately seven (7) days later.
- Any additional procedures identified during treatment that are not included in this Quotation Estimate will be communicated to you in writing prior to commencement, and a revised quotation will be issued for your approval.
- This Quotation Estimate does not constitute a guarantee of specific clinical outcomes. All dental procedures carry inherent risks, which will be discussed with you in detail during your pre-treatment consultation.
- Our practice operates in full compliance with the Health Professions Council of South Africa (HPCSA) regulations and the National Health Act (Act 61 of 2003). All patient records are maintained in accordance with the Protection of Personal Information Act (POPIA).
- For any queries regarding this Quotation Estimate or to schedule your treatment, please contact our practice at +27 21 424 7890 or visit us at 142 Sea Point Promenade, Cape Town, South Africa. Our reception team is available Monday to Friday, 08:00–17:00, and Saturday, 08:00–12:00.
By signing below, the client acknowledges receipt of this Quotation Estimate and authorises the Dentist at Cape Town Dental & Implant Centre to proceed with the treatment as described herein.
Client Signature: _________________________
Name: James van der Merwe
Date: _________________________
Dentist / Practitioner Signature: _________________________
Name: Dr. Sarah Naidoo, BDS (Hons)
HPCSA Reg. No: 0012345678
Date: _________________________
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