Quotation Estimate Dentist in Spain Barcelona –Free Word Template Download with AI
Professional Dental Services — Barcelona, Spain
VALID FOR 30 DAYS
Clínica Dental Barcelona ExcellencePasseig de Gràcia, 142, 2º 1º
08008 Barcelona, Spain
Tel: +34 93 214 5678
Email: [email protected]
NIF: B-65432109 Quotation Estimate No.: QE-2025-04872
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Marta Solé i Ferrer
License No.: COL-4521 (Col·legi Oficial de Metges de Barcelona) Client Information
| Full Name: Mr. James Alexander Whitfield | Passport / NIE: X-88421907 / X-00000000A |
| Address: Carrer de Pau Clarès, 87, 3º 2º, 08002 Barcelona, Spain | Phone: +34 612 345 678 |
| Email: [email protected] | Insurance Provider: Adeslas Seguros (Policy No. AD-2024-77812) |
This Quotation Estimate has been prepared by our licensed Dentist at Barcelona Excellence Dental Clinic following a comprehensive clinical examination, digital panoramic radiography (OPG), and intraoral photographic assessment conducted on 10 June 2025. The following services are recommended to restore full oral health and aesthetic function. All pricing is quoted in Euros (EUR) and complies with the current fee schedule regulated by the Generalitat de Catalunya and the Spanish Ministry of Health.
| Ref. | Dental Procedure / Service | Clinical Description | Unit Price (EUR) | Qty | Total (EUR) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Digital Imaging | Full clinical assessment by the attending Dentist, OPG radiograph, 6 periapical X-rays, and intraoral scan for treatment planning. | 120.00 | 1 | 120.00 |
| 02 | Ultrasonic Scaling & Polishing (Prophylaxis) | Removal of supragingival and subgingival calculus using ultrasonic scaler, followed by air-polishing and fluoride varnish application. | 95.00 | 1 | 95.00 |
| 03 | Composite Resin Restoration (Tooth #14) | Direct composite filling for a Class II carious lesion on the upper right first premolar. Includes local anaesthesia (articaine 4%), bonding agent, and occlusal adjustment. | 185.00 | 1 | 185.00 |
| 04 | Endodontic Treatment / Root Canal (Tooth #21) | Single-visit root canal therapy on the upper right central incisor. Includes rotary NiTi instrumentation, obturation with gutta-percha, and temporary restoration. Final crown to be quoted separately. | 420.00 | 1 | 420.00 |
| 05 | Ceramic (Zirconia) Crown (Tooth #21) | Fully sintered zirconia crown, 1.5 mm thickness, milled in-house using CAD/CAM technology. Includes temporary crown, try-in appointment, and final cementation with resin cement. | 650.00 | 1 | 650.00 |
| 06 | Extraction of Tooth #48 (Wisdom Tooth) | Surgical extraction of a partially impacted lower left third molar under local anaesthesia. Includes pre-operative OPG review, post-operative instructions, and one follow-up suture-removal visit. | 280.00 | 1 | 280.00 |
| 07 | Professional Teeth Whitening (In-Office) | Single-session LED-activated whitening using 35% hydrogen peroxide gel. Includes pre-treatment shade mapping, gingival protection, and post-treatment sensitivity management kit. | 250.00 | 1 | 250.00 |
| 08 | Follow-Up Review & Occlusal Check | Post-treatment review by the Dentist at 4 weeks to verify healing, restoration integrity, and occlusal harmony. Includes one additional periapical radiograph if clinically indicated. | 60.00 | 1 | 60.00 |
| Subtotal: | 2,060.00 | ||||
| VAT (IVA) 21% — Spain: | 432.60 | ||||
| TOTAL AMOUNT DUE (EUR): | 2,492.60 | ||||
- Payment Schedule: A 30% deposit (EUR 747.78) is required to confirm the first appointment. The remaining balance is payable in two equal instalments: 50% at the start of active treatment and 50% upon completion of the final procedure.
- Accepted Payment Methods: Bank transfer (IBAN: ES21 0081 5210 4300 0123 4567), credit/debit card (Visa, Mastercard, Amex), or direct debit. A 1.5% surcharge applies to card payments exceeding EUR 500.
- Insurance Reimbursement: Our clinic in Spain Barcelona is a contracted provider with Adeslas, DKV, Sanitas, and Asisa. The patient is advised to submit the itemised invoice to their insurer for partial reimbursement. The clinic will provide a certified medical report upon request.
- Validity: This Quotation Estimate remains valid for 30 calendar days from the date of issue. Prices are subject to revision in accordance with the annual fee adjustments published by the Col·legi Oficial de Metges de Barcelona.
- Cancellation Policy: Appointments cancelled with less than 48 hours' notice will incur a fee of EUR 50. Unused deposits are non-refundable once treatment has commenced.
- Warranty: All restorative work (crowns, fillings) carries a 2-year warranty against material defects. Endodontic treatment carries a 5-year warranty. Warranty does not cover damage from trauma, bruxism, or neglect of oral hygiene.
- Regulatory Compliance: All procedures are performed in strict accordance with the Spanish Organic Law 4/2015 on the Protection of Personal Data (LOPDGDD) and the EU General Data Protection Regulation (GDPR). Clinical records are stored in compliance with the Catalan Health Department (Departament de Salut) guidelines.
By signing below, the patient acknowledges that this Quotation Estimate has been explained in full by the treating Dentist, that all recommended procedures are understood, and that the patient consents to proceed with the outlined treatment plan at the stated costs. The patient confirms that no material risks or alternative treatments have been omitted from this document.
Patient SignatureMr. James Alexander Whitfield
Date: _______________ Dentist / Clinic Representative
Dr. Marta Solé i Ferrer
Barcelona Excellence Dental Clinic
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT