Quotation Estimate Dentist in United Arab Emirates Abu Dhabi –Free Word Template Download with AI
Quotation Estimate
Al Noor Dental Clinic, Level 3, Al Reem Island Tower B,
P.O. Box 12457, Abu Dhabi, United Arab Emirates
Tel: +971 2 445 6789 | Email: [email protected] License No.: DHA-ABH-2012-00847
Trade License: 1045872
VAT No.: 100458723000003
Operating Hours: Sat–Thu, 9:00 AM – 9:00 PM Quotation Estimate No. QE-2025-ABD-0347 Date of Issue 15 June 2025 Valid Until 15 July 2025 (30 Days) Prepared By Dr. Khalid Al Mansoori, DDS
Lead Dentist & Clinic Director
Note: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Should the patient wish to proceed with treatment beyond this validity period, the Dentist team at our Abu Dhabi clinic will re-evaluate the clinical condition and issue a revised Quotation Estimate at no additional charge. All procedures will be performed in strict compliance with the Department of Health – Abu Dhabi (DoH) regulatory standards and the United Arab Emirates Federal Law No. 2 of 2016 on the Organisation of Health Affairs.
Name: Mr. James Robert Anderson
Date: _______________ Authorised Dentist / Clinic Representative
Name: Dr. Khalid Al Mansoori, DDS
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
Professional Dentist Services | United Arab Emirates – Abu Dhabi
DHA Licensed Dental Practice | Est. 2012
Practice Address:Al Noor Dental Clinic, Level 3, Al Reem Island Tower B,
P.O. Box 12457, Abu Dhabi, United Arab Emirates
Tel: +971 2 445 6789 | Email: [email protected] License No.: DHA-ABH-2012-00847
Trade License: 1045872
VAT No.: 100458723000003
Operating Hours: Sat–Thu, 9:00 AM – 9:00 PM Quotation Estimate No. QE-2025-ABD-0347 Date of Issue 15 June 2025 Valid Until 15 July 2025 (30 Days) Prepared By Dr. Khalid Al Mansoori, DDS
Lead Dentist & Clinic Director
| Field | Details |
|---|---|
| Patient Name | Mr. James Robert Anderson |
| Passport / Emirates ID | P-48291037 / 784-1990-1234567-1 |
| Contact Number | +971 50 123 4567 |
| Email Address | [email protected] |
| Residential Address | Apartment 12B, Yas Island Residences, Abu Dhabi, United Arab Emirates |
| Insurance Provider | Not Applicable – Self-Pay Patient |
The following Quotation Estimate has been prepared by our senior Dentist team at Al Noor Dental Clinic in Abu Dhabi, United Arab Emirates, following a comprehensive clinical examination, digital panoramic X-ray, and intraoral photographic assessment conducted on 12 June 2025. This Quotation Estimate outlines all recommended dental procedures, associated materials, and professional fees. All pricing is quoted in United Arab Emirates Dirhams (AED) and is inclusive of applicable Value Added Tax (VAT) at the standard rate of 5% as mandated by the Federal Tax Authority of the United Arab Emirates.
| Ref | Dental Procedure / Service | Description | Qty | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Consultation | Full oral assessment by a qualified Dentist, digital OPG X-ray, intraoral photography, and treatment planning session at our Abu Dhabi clinic. | 1 | 350.00 | 350.00 |
| 02 | Ultrasonic Scaling & Polishing (Prophy) | Professional deep cleaning using ultrasonic scaler and hand instruments, followed by fluoride varnish application. Performed by a registered dental hygienist under Dentist supervision. | 1 | 650.00 | 650.00 |
| 03 | Composite Resin Restorations (Tooth #14, #24) | Removal of carious dentine and placement of 3M Z350 XT nanohybrid composite resin. Two-surface restoration per tooth, shade-matched to natural dentition. | 2 | 850.00 | 1,700.00 |
| 04 | Root Canal Treatment – Molar (Tooth #36) | Complete endodontic treatment including access cavity preparation, canal instrumentation, obturation with gutta-percha, and temporary restoration. Performed by a specialist endodontic Dentist. | 1 | 3,200.00 | 3,200.00 |
| 05 | Full-Ceramic Crown (Tooth #36) | Lithium disilicate (e.max) full-ceramic crown fabricated in-house using CAD/CAM technology. Includes temporary crown, try-in, and final cementation with resin cement. | 1 | 2,800.00 | 2,800.00 |
| 06 | Wisdom Tooth Extraction (Tooth #48) | Surgical extraction of impacted lower right third molar under local anaesthesia. Includes pre-operative radiograph, post-operative instructions, and one follow-up review. | 1 | 1,500.00 | 1,500.00 |
| 07 | Professional Teeth Whitening (In-Clinic) | Single-visit in-office whitening using 35% hydrogen peroxide gel with LED activation. Includes pre-whitening shade assessment and post-whitening desensitising gel. | 1 | 1,200.00 | 1,200.00 |
| 08 | Follow-Up Review & Post-Operative Check | Two follow-up appointments (one week and one month post-treatment) for healing assessment, suture removal if applicable, and final polishing. | 2 | 150.00 | 300.00 |
| 09 | Prescription Medication & Post-Op Kit | Antibiotics (Amoxicillin 500mg x10), analgesics (Ibuprofen 400mg x10), chlorhexidine mouthwash 200ml, and soft-bristle toothbrush. | 1 | 250.00 | 250.00 |
| Subtotal (AED) | 11,950.00 | ||||
| VAT @ 5% (AED) | 597.50 | ||||
| GRAND TOTAL (AED) | 12,547.50 | ||||
- This Quotation Estimate is a non-binding document and does not constitute a contract until formally accepted in writing by the patient and countersigned by the authorised representative of Al Noor Dental Clinic, Abu Dhabi, United Arab Emirates.
- All dental treatments described in this Quotation Estimate will be carried out by a licensed Dentist or dental specialist registered with the Department of Health – Abu Dhabi (DoH) and the UAE Medical Council.
- Payment is due in full prior to the commencement of any procedure, unless a written payment plan has been mutually agreed upon. Accepted payment methods include bank transfer, credit/debit card (Visa, Mastercard, Amex), and cash. A 5% late payment surcharge applies to outstanding balances exceeding 14 days.
- The patient acknowledges that all dental procedures, including those performed by our Dentist team, carry inherent risks. A detailed informed consent form will be provided and signed prior to each procedure in accordance with UAE medical ethics regulations.
- A warranty period of twelve (12) months applies to all restorative work (crowns, bridges, composite fillings) against material defects under normal use. This warranty does not cover damage resulting from trauma, neglect, or failure to attend scheduled follow-up appointments.
- The patient may cancel or reschedule any appointment with a minimum of 24 hours' notice. Cancellations made within 24 hours or no-shows will incur a fee of AED 200 per missed appointment.
- All patient records, radiographs, and clinical data are stored in compliance with the UAE Federal Decree-Law No. 45 of 2021 on the Protection of Personal Data. Data will not be shared with third parties without explicit written consent.
- This Quotation Estimate is governed by the laws of the United Arab Emirates, and any disputes shall be subject to the exclusive jurisdiction of the courts of Abu Dhabi, UAE.
- Al Noor Dental Clinic reserves the right to modify the treatment plan and issue a supplementary Quotation Estimate should additional clinical findings be discovered during the course of treatment.
By signing below, the patient confirms that they have read, understood, and accept all terms and conditions outlined in this Quotation Estimate. The patient authorises Al Noor Dental Clinic, Abu Dhabi, United Arab Emirates, to proceed with the dental treatments as described herein.
Patient SignatureName: Mr. James Robert Anderson
Date: _______________ Authorised Dentist / Clinic Representative
Name: Dr. Khalid Al Mansoori, DDS
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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