Quotation Estimate Dentist in United Kingdom Birmingham –Free Word Template Download with AI
142 New Street, Birmingham, B2 4HA, United Kingdom
Telephone: 0121 496 0000 | Email: [email protected]
Registered with the General Dental Council (GDC) | Practice No. 88421
VAT Registration No. GB 123 4567 89
Quotation Details
Quotation Reference: QTE-BHM-2025-04872
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Sarah Whitfield, BDS, MSc, FDSRCS
Practice Location: Birmingham, United Kingdom
Client / Patient Details
Patient Name: Mr. James R. Thompson
Address: 27 Edgbaston Crescent, Birmingham, B15 2TN, United Kingdom
NHS Number: 485 777 3456
Telephone: 07700 900123
Email: [email protected]
Scope of Dental Treatment – Quotation Estimate Breakdown
This Quotation Estimate has been prepared by Birmingham City Dental Practice, a registered dental clinic located in the heart of Birmingham, United Kingdom, following a comprehensive clinical examination and diagnostic assessment carried out on 10 June 2025. The following itemised costs represent the estimated fees for the proposed course of dental treatment. All prices are quoted in British Pounds Sterling (GBP) and include applicable Value Added Tax (VAT) at the current rate of 20% where applicable under United Kingdom tax legislation.
| Ref | Dental Procedure / Service | Description | Qty | Unit Price (GBP) | Total (GBP) |
|---|---|---|---|---|---|
| 01 | Comprehensive Dental Examination | Full intraoral and extraoral examination, digital panoramic X-ray (OPG), and clinical assessment by a qualified Dentist in Birmingham. | 1 | £85.00 | £85.00 |
| 02 | Full Mouth Scaling and Polishing | Ultrasonic and hand scaling of all 28 visible teeth, followed by professional polishing. Performed by a registered Dental Hygienist at our Birmingham, United Kingdom clinic. | 1 | £120.00 | £120.00 |
| 03 | Composite Dental Fillings (x3) | Placement of three aesthetic composite resin restorations on teeth 24, 25, and 36. Includes local anaesthesia, isolation, and post-operative instructions. | 3 | £185.00 | £555.00 |
| 04 | Root Canal Treatment (Tooth 16) | Single-root endodontic treatment including access cavity preparation, canal instrumentation, obturation, and temporary restoration. Carried out by an endodontic specialist Dentist in Birmingham. | 1 | £450.00 | £450.00 |
| 05 | Ceramic Crown (Tooth 16) | Full zirconia ceramic crown to restore structural integrity following root canal treatment. Includes impression, temporary crown, and final cementation appointment. | 1 | £680.00 | £680.00 |
| 06 | Wisdom Tooth Extraction (Tooth 38) | Surgical removal of a partially erupted lower left third molar under local anaesthesia. Includes pre-operative radiograph, post-operative review, and prescription for analgesia and antibiotics if required. | 1 | £320.00 | £320.00 |
| 07 | Post-Operative Review and Follow-Up | Two follow-up appointments at 2 weeks and 6 weeks to monitor healing, verify restoration integrity, and provide ongoing dental care advice from our Birmingham practice team. | 2 | £45.00 | £90.00 |
| 08 | Dental Sedation (Nitrous Oxide) | Entonox (laughing gas) sedation administered during the wisdom tooth extraction procedure to ensure patient comfort and reduce anxiety. Supervised by a qualified Dentist in Birmingham, United Kingdom. | 1 | £75.00 | £75.00 |
| Subtotal (Excluding VAT): | £2,375.00 | ||||
| VAT @ 20% (where applicable): | £475.00 | ||||
| TOTAL ESTIMATED COST (Including VAT): | £2,850.00 | ||||
Payment Terms and Conditions
- Quotation Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision due to changes in material costs, clinical circumstances, or regulatory requirements within the United Kingdom.
- Payment Schedule: A deposit of 25% (£712.50) is required to confirm the treatment plan and secure appointment slots at our Birmingham, United Kingdom practice. The remaining balance of 75% (£2,137.50) is payable upon completion of all procedures.
- Accepted Payment Methods: We accept bank transfer (BACS), debit/credit card (Visa, Mastercard, Maestro), and direct debit. All transactions are processed securely in accordance with United Kingdom data protection regulations (UK GDPR).
- NHS vs. Private: This Quotation Estimate is for private dental treatment. If the patient wishes to access NHS-funded dental services available in Birmingham, a separate referral and assessment process will apply, and costs will be determined by the NHS dental tariff in force at the time of treatment.
- Warranty: All restorative work (fillings, crowns) carries a 12-month warranty from the date of final cementation, provided the patient attends all scheduled recall appointments at our Birmingham dental clinic.
- Cancellations: Appointments cancelled with less than 48 hours' notice may incur a fee of £50.00 per missed appointment, in line with standard practice policies in Birmingham, United Kingdom.
- Complaints: Any concerns regarding the treatment or this Quotation Estimate should be directed to the Practice Manager. Formal complaints may be escalated to the General Dental Council (GDC) or the Care Quality Commission (CQC), both of which regulate dental services in the United Kingdom.
- Confidentiality: All patient records and clinical data are stored in strict compliance with the UK Data Protection Act 2018 and the NHS Confidentiality Code of Practice.
Acceptance and Authorisation
By signing below, the patient confirms that they have read and understood this Quotation Estimate, that the proposed dental treatment plan has been explained in full by the treating Dentist, and that they consent to proceed with the treatment as outlined above at Birmingham City Dental Practice, Birmingham, United Kingdom.
Patient Signature & DateMr. James R. Thompson
Dentist / Practitioner Signature & DateDr. Sarah Whitfield, BDS, MSc, FDSRCS
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT