Quotation Estimate Orthodontist in Algeria Algiers –Free Word Template Download with AI

Quotation No.: ORTH-ALG-2025-0472
Date Issued: 15 June 2025
Valid Until: 15 July 2025 Prepared By: Dr. Amel Benali, DMD, MSc
Clinic: Clinique Dentaire Algérienne
Address: 42, Rue Didouche Mourad, Hydra, Algiers, Algeria
Phone: +213 (0) 23 45 67 89
Email: [email protected] 1. Client Information

Patient Name:	Mr. Yacine Haddad
National ID / CIN:	189045678
Residence:	El Biar, Algiers, Algeria
Referring Physician:	Dr. Karim Mansouri (General Dentist, Algiers)

2. Scope of Orthodontist Services

This Quotation Estimate has been prepared by our qualified Orthodontist at Clinique Dentaire Algérienne, located in the heart of Algeria Algiers, to provide a comprehensive and transparent breakdown of all anticipated orthodontic treatment costs. The following services have been recommended following a full clinical examination, panoramic radiograph (OPG), intraoral photography, and digital study-model analysis conducted on 10 June 2025.

3. Itemized Cost Breakdown

Ref.	Description of Orthodontist Service	Qty	Unit Price (DZD)	Total (DZD)
01	Initial Orthodontic Consultation & Diagnostic Workup (OPG, CBCT scan, intraoral scans, cephalometric analysis)	1	18,500	18,500
02	Orthodontist Treatment Planning & Digital Simulation (3D treatment plan, mock-up, patient consultation)	1	12,000	12,000
03	Placement of Ceramic (Tooth-Coloured) Brackets & Archwires — Upper and Lower Arch	1	145,000	145,000
04	Monthly Orthodontist Adjustment Visits (wire changes, elastic adjustments, progress monitoring) — 18 sessions	18	8,500	153,000
05	Interproximal Reduction (IPR) & Minor Tooth Contouring (if required during active treatment)	1	25,000	25,000
06	Removal of Brackets, Bonding of Fixed Retainers (upper & lower) & Fabrication of Removable Retainers (Hawley type)	1	38,000	38,000
07	Post-Treatment Orthodontist Follow-Up & Retainer Checks (6 months, 12 months, 24 months)	3	5,000	15,000
08	Emergency Orthodontist Appointment (broken bracket, wire irritation) — included up to 2 visits	2	4,500	9,000
SUBTOTAL				415,500 DZD
VAT (19% — applicable per Algerian tax regulations)				78,945 DZD
GRAND TOTAL				494,445 DZD

Note: This Quotation Estimate is based on the current treatment plan as of the date of issue. Should the Orthodontist determine, during the course of active treatment, that additional procedures are clinically necessary (e.g., extraction of premolars, placement of mini-implants for anchorage, or extended retention), a supplementary Quotation Estimate will be issued and must be approved in writing by the patient before any additional work commences. All prices are quoted in Algerian Dinars (DZD) and are inclusive of all materials used in Algeria Algiers. 4. Payment Terms

The total amount of this Quotation Estimate may be settled according to the following schedule, as agreed between the patient and the Orthodontist's clinic in Algeria Algiers:

Installment	Due Date	Amount (DZD)
Deposit (upon acceptance of this Quotation Estimate)	15 June 2025	100,000
Second Payment (at bracket placement)	1 July 2025	150,000
Third Payment (mid-treatment, month 9)	1 March 2026	120,000
Final Payment (at debonding & retainer delivery)	1 January 2027	124,445

Accepted payment methods include bank transfer (CIB, BNA, BNA), cash, and certified cheque. A receipt will be issued for every payment made at the clinic in Algeria Algiers.

5. Terms & Conditions

Important Conditions Governing This Quotation Estimate

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, the Orthodontist reserves the right to revise pricing due to changes in material costs or exchange-rate fluctuations applicable in Algeria.
The estimated treatment duration is approximately eighteen (18) months, subject to the patient's compliance with the Orthodontist's instructions, including dietary restrictions, oral hygiene maintenance, and attendance at all scheduled adjustment appointments in Algiers.
Failure to attend a scheduled Orthodontist appointment without at least 48 hours' prior notice will result in a no-show fee of 5,000 DZD per occurrence.
The Orthodontist at this clinic in Algeria Algiers is a licensed specialist registered with the Algerian Order of Dentists (Ordre National des Chirurgiens-Dentistes d'Algérie). All treatments comply with the standards set by the Ministry of Health of the People's Democratic Republic of Algeria.
This Quotation Estimate does not constitute a guarantee of a specific aesthetic outcome. The Orthodontist will use reasonable professional judgment to achieve the best possible result within the biological limits of the patient's dentition.
Any dispute arising from the services described in this Quotation Estimate shall be resolved through the competent courts of Algiers, Algeria, in accordance with Algerian civil and commercial law.
The patient acknowledges that by signing below, they accept this Quotation Estimate in full and authorize the Orthodontist to commence treatment as outlined herein.

6. Acceptance & Signatures

For the Orthodontist / Clinic

Dr. Amel Benali, DMD, MSc
Clinique Dentaire Algérienne
Algiers, Algeria

Signature & Date

Patient / Legal Guardian

Mr. Yacine Haddad
CIN: 189045678
El Biar, Algiers, Algeria

Signature & Date

— End of Quotation Estimate —
This document was generated by Clinique Dentaire Algérienne, Algeria Algiers. For any queries regarding this Quotation Estimate, please contact our Orthodontist team at +213 (0) 23 45 67 89.

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