Quotation Estimate Dentist in Switzerland Zurich –Free Word Template Download with AI
Bahnhofstrasse 42, 8001 Zürich, Switzerland | Tel: +41 44 555 12 34 | Email: [email protected]
Swiss Dental Association Member | Licensed Dentist Practice in Switzerland Zurich
Quotation EstimateQuotation Details
Quotation No.: QE-2025-0847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Currency: Swiss Francs (CHF)
Prepared By: Dr. med. dent. Anna Keller, Lead Dentist
Client Information
Name: Mr. Thomas Berger
Address: Seefeldstrasse 118, 8008 Zürich, Switzerland
Phone: +41 79 123 45 67
Email: [email protected]
Insurance: Swiss Dental Insurance (Krankentaggeld)
Dear Mr. Berger,
Thank you for visiting our Dentist practice in Switzerland Zurich for your comprehensive dental consultation on 10 June 2025. Following a thorough clinical examination, digital X-ray imaging, and periodontal assessment, our team has prepared this detailed Quotation Estimate outlining the recommended treatment plan, associated costs, and applicable insurance coverage under Swiss dental regulations. This Quotation Estimate is issued in accordance with the Swiss Federal Dental Fee Schedule (TARMED) and reflects the standard rates practiced by a licensed Dentist in the canton of Zürich.
Itemized Treatment Plan & Cost Breakdown| Ref. | Dental Procedure / Service | Description | Quantity | Unit Price (CHF) | Total (CHF) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination | Full oral assessment, digital panoramic X-ray, and periodontal charting by the supervising Dentist in Switzerland Zurich | 1 | 185.00 | 185.00 |
| 02 | Professional Dental Hygiene (Scaling & Polishing) | Ultrasonic scaling, air-polishing, and fluoride application for all 28 remaining teeth | 1 | 245.00 | 245.00 |
| 03 | Root Canal Treatment (Tooth #16) | Endodontic therapy including access cavity, canal instrumentation, obturation, and temporary restoration | 1 | 890.00 | 890.00 |
| 04 | Ceramic Crown (Tooth #16) | Full zirconia ceramic crown, laboratory fabrication, try-in, and final cementation by the Dentist | 1 | 1,450.00 | 1,450.00 |
| 05 | Composite Filling (Tooth #24) | Direct composite restoration, two-surface, including shade matching and polishing | 1 | 320.00 | 320.00 |
| 06 | Extraction of Tooth #48 (Wisdom Tooth) | Surgical extraction under local anaesthesia, including post-operative instructions and follow-up suture removal | 1 | 580.00 | 580.00 |
| 07 | Follow-Up Consultation (Week 2 & Week 6) | Two post-operative review appointments with the treating Dentist in Switzerland Zurich | 2 | 95.00 | 190.00 |
| 08 | Digital Intraoral Photography & Records | High-resolution intraoral imaging for treatment documentation and insurance submission | 1 | 75.00 | 75.00 |
| Subtotal | 3,935.00 | ||||
| Estimated Insurance Reimbursement (Swiss Dental Insurance) | -1,862.25 | ||||
| Patient Co-Payment (Deductible & Co-insurance) | 2,072.75 | ||||
- This Quotation Estimate is a good-faith projection of costs based on the clinical findings at the time of examination. The final invoice issued by our Dentist practice in Switzerland Zurich may vary by up to 10% should additional procedures become necessary during treatment.
- All fees are quoted in Swiss Francs (CHF) and are inclusive of applicable Swiss Value Added Tax (VAT) at the standard rate of 8.1%, as mandated by the Federal Tax Administration of Switzerland.
- The estimated insurance reimbursement is calculated based on the standard Swiss dental insurance (Zusatzversicherung) benefits. The actual reimbursement amount is subject to confirmation by your insurance provider and may differ depending on your specific policy terms, annual deductible, and co-insurance percentage.
- This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, the Dentist practice reserves the right to revise pricing due to changes in material costs, laboratory fees, or Swiss regulatory fee schedules.
- The treatment plan outlined in this Quotation Estimate has been designed and approved by Dr. med. dent. Anna Keller, a fully licensed Dentist registered with the Swiss Medical Association (FMH) and the cantonal medical authority of Zürich.
- Payment of the patient co-payment portion is due within 30 days of the final invoice. Our practice in Switzerland Zurich accepts payment via bank transfer (SEPA), credit card (Visa, Mastercard), and TWINT. Instalment arrangements may be discussed with our practice coordinator for treatments exceeding CHF 2,000.
- All dental work performed by our Dentist team carries a minimum 12-month warranty on restorative materials (crowns, bridges, fillings). This warranty does not cover damage resulting from trauma, neglect, or non-compliance with post-operative care instructions.
- In accordance with Swiss data protection law (DSG), all patient records, digital imaging, and this Quotation Estimate document are stored securely and will be retained for the statutory period of 10 years as required by the Swiss Federal Act on Medical Data Protection.
- Should you wish to decline any portion of the recommended treatment, please inform our practice in writing. The Dentist will document the informed refusal in your clinical file, and the Quotation Estimate will be adjusted accordingly.
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed treatment plan, and authorizes the Dentist practice in Switzerland Zurich to proceed with the outlined procedures. The client further confirms that all relevant information regarding risks, alternatives, and expected outcomes has been provided in a clear and comprehensible manner.
Client Signature & DateMr. Thomas Berger
Dentist / Practice RepresentativeDr. med. dent. Anna Keller, Zürich Dental Practice AG
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT