Quotation Estimate Dentist in Uganda Kampala –Free Word Template Download with AI
Plot 14, Kampala Road, P.O. Box 3215, Kampala, Uganda
Tel: +256 772 345 678 | Email: [email protected]
Uganda Dental Council Registration No: UDC/2019/00482
Quotation Estimate| Quotation Estimate No. | KSDC/QE/2025/00347 |
| Date of Issue | 12 June 2025 |
| Valid Until | 12 July 2025 (30 days from date of issue) |
| Prepared For | Mr. James Okello – Plot 7, Ntinda Avenue, Kampala, Uganda |
| Prepared By | Dr. Sarah Namutebi, Lead Dentist, Kampala Smile Dental Clinic |
| Currency | Ugandan Shillings (UGX) |
Dear Mr. Okello,
Thank you for visiting Kampala Smile Dental Clinic on 5 June 2025 for a comprehensive dental consultation. Following your clinical examination, full-mouth radiographs, and periodontal assessment, we are pleased to present this Quotation Estimate detailing the recommended course of dental treatment. This Quotation Estimate has been prepared in accordance with the standards set by the Uganda Dental Council and reflects current market rates for dental services in Kampala, Uganda.
Please note that this Quotation Estimate is a good-faith projection of costs and may be subject to minor adjustments should additional clinical findings emerge during the course of treatment. All prices are inclusive of applicable taxes as mandated by the Uganda Revenue Authority.
Itemized Dental Services – Quotation Estimate Breakdown| No. | Description of Dental Service | Quantity | Unit Price (UGX) | Total (UGX) |
|---|---|---|---|---|
| 1 | Comprehensive Dental Consultation & Treatment Planning (Kampala, Uganda) | 1 session | 150,000 | 150,000 |
| 2 | Full-Mouth Panoramic Radiograph (OPG) & Periapical X-Rays | 1 set | 250,000 | 250,000 |
| 3 | Ultrasonic Scaling & Polishing (Prophylaxis) – Upper & Lower Arch | 2 sessions | 300,000 | 600,000 |
| 4 | Root Canal Treatment – Mandibular Molar (Tooth #36) | 1 tooth | 1,200,000 | 1,200,000 |
| 5 | Full-Ceramic Crown (E.max) – Mandibular Molar (Tooth #36) | 1 unit | 1,800,000 | 1,800,000 |
| 6 | Composite Resin Restorations – Anterior Teeth (Teeth #11, #21) | 2 teeth | 450,000 | 900,000 |
| 7 | Extraction of Impacted Wisdom Tooth – Maxillary Right (Tooth #18) | 1 tooth | 800,000 | 800,000 |
| 8 | Periodontal Deep Cleaning (Scaling & Root Planing) – 4 Quadrants | 4 quadrants | 350,000 | 1,400,000 |
| 9 | Follow-Up Consultations & Post-Operative Reviews (3 visits) | 3 sessions | 100,000 | 300,000 |
| 10 | Prescription Medication (Antibiotics, Analgesics, Chlorhexidine Rinse) | 1 course | 120,000 | 120,000 |
| Subtotal | 7,520,000 | |||
| VAT (18% – Uganda Revenue Authority) | 1,353,600 | |||
| GRAND TOTAL (UGX) | 8,873,600 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, prices may be revised to reflect current dental supply costs in Kampala, Uganda.
- Payment is due within fourteen (14) days of acceptance of this Quotation Estimate. A 50% deposit is required to schedule the first treatment appointment at our Kampala clinic.
- Accepted payment methods include: Mobile Money (MTN, Airtel), bank transfer to Kampala Smile Dental Clinic (Bank of Uganda, Account No. 0045-8821-3367), or cash at the clinic reception.
- All dental procedures outlined in this Quotation Estimate will be performed by a registered and licensed Dentist in good standing with the Uganda Dental Council. Assistants and hygienists will be certified dental professionals.
- Should the Dentist identify additional clinical needs during treatment that were not apparent at the initial examination, a supplementary Quotation Estimate will be issued and your written consent will be obtained before any additional work commences.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic or functional outcomes. The Dentist will exercise reasonable professional judgment in line with accepted standards of dental practice in Uganda.
- A warranty of twelve (12) months applies to all restorative work (crowns, composite fillings) provided no damage results from patient negligence, trauma, or failure to attend scheduled follow-up appointments.
- All patient records, radiographs, and treatment plans will be maintained in accordance with the Uganda Data Protection and Privacy Act, 2019.
- By signing below, the patient acknowledges receipt and acceptance of this Quotation Estimate and authorizes the Dentist at Kampala Smile Dental Clinic to proceed with the described treatment plan.
For: Kampala Smile Dental Clinic
Dr. Sarah Namutebi, BDS, MSc (Dentistry)Lead Dentist & Clinic Director
Date: _______________
Patient Acceptance
Mr. James OkelloPatient / Authorized Representative
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT