Quotation Estimate Dentist in United Arab Emirates Dubai –Free Word Template Download with AI
Al Marjan Dental Clinic LLC
Level 3, Marina Plaza Tower, Dubai Marina, Dubai, United Arab Emirates
Tel: +971 4 555 8920 | Email: [email protected]
Trade License No: 1045872 | DHA License No: DHA-2024-00387
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 Prepared For:
Mr. James A. Whitfield
Villa 42, Palm Jumeirah, Dubai
United Arab Emirates
Passport No: GB-55829147 1. SCOPE OF DENTAL SERVICES — DUBAI, UNITED ARAB EMIRATES
This Quotation Estimate has been prepared by Al Marjan Dental Clinic LLC, a fully licensed and registered dental practice operating in Dubai, United Arab Emirates, in compliance with the regulations set forth by the Dubai Health Authority (DHA) and the Ministry of Health and Prevention (MOHAP). The following itemized services represent the complete dental treatment plan recommended for the patient following a comprehensive clinical examination and diagnostic imaging conducted on 12 June 2025 at our Dubai Marina facility. All procedures will be performed by board-certified dentists and dental specialists holding valid DHA professional licenses.
2. ITEMIZED QUOTATION ESTIMATE — DENTAL TREATMENT PLAN| Ref | Dental Procedure / Service | Description | Qty | Unit Price (AED) | Subtotal (AED) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination & Digital X-Rays | Full intraoral examination, panoramic OPG, and 4 periapical radiographs | 1 | 450.00 | 450.00 |
| 02 | Ultrasonic Scaling & Polishing (Prophy) | Full-mouth supragingival and subgingival scaling with fluoride varnish application | 1 | 650.00 | 650.00 |
| 03 | Composite Resin Restorations (Posterior) | Multi-surface Class II composite fillings on teeth #14, #15, #24, #25 | 4 | 750.00 | 3,000.00 |
| 04 | Root Canal Treatment (Single-Root Molar) | Complete endodontic therapy on tooth #36 including gutta-percha obturation | 1 | 2,800.00 | 2,800.00 |
| 05 | Full-Ceramic Crown (E.max Zirconia) | Post-endodontic full ceramic crown on tooth #36, including temporary crown | 1 | 3,500.00 | 3,500.00 |
| 06 | Wisdom Tooth Extraction (Lower Left) | Surgical extraction of tooth #38 under local anesthesia with suturing | 1 | 1,200.00 | 1,200.00 |
| 07 | Professional Teeth Whitening (In-Office) | Single-session LED-assisted whitening using 35% hydrogen peroxide gel | 1 | 1,500.00 | 1,500.00 |
| 08 | Follow-Up Consultations & Adjustments | Two post-treatment review visits including bite adjustment and radiographic verification | 2 | 200.00 | 400.00 |
| 09 | Prescription Medications & Post-Operative Kit | Antibiotics, analgesics, chlorhexidine mouthwash, and soft diet guidance | 1 | 180.00 | 180.00 |
| SUBTOTAL (AED) | 13,680.00 | ||||
| VAT @ 5% (United Arab Emirates) | 684.00 | ||||
| TOTAL QUOTATION ESTIMATE (AED) | 14,364.00 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision based on material costs and prevailing market rates in Dubai, United Arab Emirates.
- Payment terms: A deposit of 50% of the total Quotation Estimate is required to schedule the first treatment appointment. The remaining balance is due upon completion of all procedures. Payments may be made via bank transfer, credit/debit card, or cash at our Dubai Marina clinic.
- All dental treatments outlined in this Quotation Estimate will be performed in strict adherence to the clinical guidelines issued by the Dubai Health Authority (DHA) and the Ministry of Health and Prevention (MOHAP) of the United Arab Emirates.
- The patient consents to the use of digital imaging, electronic health records, and any necessary laboratory services within the United Arab Emirates. All patient data is handled in compliance with UAE data protection regulations.
- Any additional procedures not listed in this Quotation Estimate, if clinically necessary during treatment, will be communicated to the patient in writing prior to commencement, with a revised Quotation Estimate provided for approval.
- Warranty: All ceramic crowns and composite restorations carry a twelve (12) month warranty against manufacturing defects under normal use. The warranty does not cover damage resulting from trauma, bruxism, or failure to attend scheduled follow-up appointments.
- This Quotation Estimate is non-transferable and is issued exclusively for the named patient. It does not constitute a binding contract until both parties have signed and the initial deposit has been received.
- In the event of any dispute arising from the services described herein, the matter shall be resolved in accordance with the laws of the United Arab Emirates, and the competent courts of Dubai shall have exclusive jurisdiction.
- The patient is advised to attend all scheduled follow-up appointments. Cancellations must be made at least 48 hours in advance to avoid a no-show fee of AED 200 per missed appointment.
By signing below, the patient acknowledges that this Quotation Estimate for dental services in Dubai, United Arab Emirates, has been reviewed and understood. The patient authorizes Al Marjan Dental Clinic LLC to proceed with the recommended treatment plan as itemized above, subject to the terms and conditions stated herein.
Patient SignatureName: Mr. James A. Whitfield
Date: _______________ Authorized Dental Practitioner
Dr. Fatima Al Rashidi, BDS, MSc (Endo)
DHA License No: DHA-2024-00387
Al Marjan Dental Clinic LLC, Dubai, UAE
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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