Quotation Estimate Dentist in Venezuela Caracas –Free Word Template Download with AI
Clínica Dental Caracas Excellence
Av. Francisco de Miranda, Torre Empresarial, Piso 12, Chacao, Caracas, Venezuela
Phone: +58 (212) 555-0147 | Email: [email protected]
RIF: J-45872319-0 | Ministry of Health License No. MD-2019-00482
Quotation No.: QE-2025-04871 Date Issued: June 12, 2025 Valid Until: July 12, 2025 Location: Caracas, Venezuela CLIENT INFORMATIONPrepared For
Name: María Alejandra Rodríguez Pérez
CI: V-18.452.391
Address: Urbanización Los Palos Grandes, Caracas, Venezuela
Phone: +58 (412) 789-3321
Email: [email protected]
Prepared By
Dentist: Dr. Carlos Eduardo Mendoza, DDS
Specialty: General & Restorative Dentistry
License: C.M. No. 12.847 (Ministerio del Poder Popular para la Salud, Venezuela)
Office: Caracas, Venezuela
Consultation Date: June 10, 2025
ITEMIZED DENTAL SERVICES – QUOTATION ESTIMATE| # | Dental Procedure / Service | Description | Qty | Unit Price (VES) | Subtotal (VES) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Digital X-Rays | Full oral assessment, panoramic radiograph, and periapical X-rays (4 views) performed at our Caracas clinic. | 1 | 1,850.00 | 1,850.00 |
| 2 | Professional Dental Cleaning & Scaling (Prophylaxis) | Ultrasonic scaling, hand scaling, polishing, and fluoride varnish application. Recommended twice yearly for optimal oral health in the Caracas region. | 2 | 2,400.00 | 4,800.00 |
| 3 | Composite Resin Fillings (Tooth-Colored Restorations) | Placement of high-quality composite resin fillings for moderate cavities detected on teeth #14 and #21. Includes local anesthesia and post-operative instructions. | 2 | 5,200.00 | 10,400.00 |
| 4 | Root Canal Treatment (Endodontic Therapy) | Complete endodontic treatment for tooth #36 (mandibular first molar). Includes access cavity preparation, canal instrumentation, obturation, and temporary restoration. Performed by Dr. Mendoza in Caracas. | 1 | 18,500.00 | 18,500.00 |
| 5 | Porcelain Crown (Full-Ceramic Restoration) | Custom-fabricated full-ceramic crown for tooth #36 following root canal completion. Includes impression, temporary crown, and final cementation. Crown manufactured by certified dental laboratory in Caracas. | 1 | 22,000.00 | 22,000.00 |
| 6 | Orthodontic Consultation & Treatment Plan | Initial orthodontic evaluation, digital photography, study models, and written treatment plan for mild crowding in the anterior region. No braces applied at this stage. | 1 | 3,200.00 | 3,200.00 |
| 7 | Periodontal Maintenance & Deep Cleaning (Scaling & Root Planing) | Subgingival scaling and root planing for four quadrants. Addresses early-stage periodontal disease identified during the initial examination in Caracas. | 1 | 9,800.00 | 9,800.00 |
| 8 | Follow-Up Visits & Post-Operative Care | Three (3) follow-up appointments for suture removal, crown adjustment, and general check-ups. Includes complimentary fluoride treatment at each visit. | 3 | 800.00 | 2,400.00 |
| Subtotal (All Dental Services) | 72,950.00 VES |
| Applicable Tax (IVA 16% – Venezuela) | 11,672.00 VES |
| Discount – New Patient in Caracas (5%) | -3,647.50 VES |
| TOTAL QUOTATION ESTIMATE | 80,974.50 VES |
| Approximate USD Equivalent (at current BCV rate) | ~$1,454.08 USD |
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to change based on fluctuations in the Venezuelan Bolívar (VES) exchange rate as published by the Banco Central de Venezuela (BCV).
- Payment Schedule: A 40% advance payment is required to schedule the first dental appointment. The remaining 60% is due upon completion of all procedures. Installment plans of up to three (3) monthly payments are available for clients residing in Caracas and surrounding areas (Baruta, Chacao, El Hatillo).
- Accepted Payment Methods: Bank transfer (Banesco, Mercantil, Provincial, BDV), Zelle, PayPal, and cash in VES or USD at the clinic office in Caracas. All transactions are processed in compliance with Venezuelan financial regulations.
- Warranty: All restorative dental work (crowns, fillings, root canals) carries a twelve (12) month warranty from the date of final cementation or completion. Warranty covers material defects and does not cover damage from trauma, neglect, or non-compliance with post-operative instructions.
- Scheduling: Appointments are available Monday through Friday, 8:00 AM to 6:00 PM, and Saturday 9:00 AM to 1:00 PM at our clinic in Chacao, Caracas. Emergency dental care is available by phone during business hours.
- Cancellations: Cancellations must be made at least 24 hours in advance. Late cancellations or no-shows will incur a fee of 20% of the scheduled procedure cost.
- Confidentiality: All patient records, radiographic images, and treatment plans are handled in strict accordance with Venezuelan data protection laws and the ethical code of the Colegio de Odontólogos de Venezuela.
- Scope of Work: This Quotation Estimate covers only the procedures listed above. Any additional dental treatments identified during the course of care will be communicated to the patient in writing before proceeding, with a separate Quotation Estimate provided.
Dear Ms. Rodríguez, based on the comprehensive examination conducted on June 10, 2025, at our dental office in Caracas, Venezuela, I strongly recommend proceeding with the treatment plan outlined in this Quotation Estimate. The root canal therapy and subsequent porcelain crown on tooth #36 are essential to prevent further infection and preserve the natural tooth structure. The periodontal maintenance is critical to halt the progression of early gum disease, which is particularly prevalent in the Caracas region due to dietary and environmental factors.
I encourage you to schedule the initial procedures within the next two weeks to minimize discomfort and reduce the overall treatment timeline. My team and I are committed to providing you with the highest standard of dental care in Caracas, Venezuela, using state-of-the-art equipment and internationally sourced materials.
Please do not hesitate to contact our office at +58 (212) 555-0147 if you have any questions regarding this Quotation Estimate or wish to discuss alternative treatment options.
Dr. Carlos Eduardo Mendoza, DDSLead Dentist – Clínica Dental Caracas Excellence
C.M. No. 12.847 | Caracas, Venezuela Patient Acknowledgment
María Alejandra Rodríguez Pérez
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT