Quotation Estimate Orthodontist in Argentina Buenos Aires –Free Word Template Download with AI
Dr. Mariana López – Orthodontist
Av. Corrientes 2450, Piso 3, Of. 32
Buenos Aires, C1043AAB – Argentina
Tel: +54 11 4321-5678 | Email: [email protected]
CUIT: 27-12345678-9 | Matricula: 45678/BA
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 Client Name: [Patient Full Name]
DNI: [XXXXXXXX]
Address: [Patient Address, Buenos Aires, Argentina]
1. Purpose of This Quotation Estimate
This Quotation Estimate has been prepared by our Orthodontist practice located in the heart of Buenos Aires, Argentina, to provide the patient with a comprehensive, transparent, and detailed financial breakdown of the proposed orthodontic treatment plan. As a licensed Orthodontist registered with the Colegio de Odontólogos de la Ciudad de Buenos Aires, Dr. Mariana López is committed to delivering the highest standard of dental care in accordance with the regulations established by the Argentine Ministry of Health. This document serves as a formal Quotation Estimate and does not constitute a binding contract until both parties have signed and accepted all terms outlined herein.
2. Clinical Diagnosis and Treatment Plan
Following a thorough clinical examination, radiographic analysis (panoramic X-ray and cephalometric study), and digital intraoral scanning performed at our clinic in Buenos Aires, Argentina, the following diagnosis has been established: Class II malocclusion with moderate crowding in the anterior maxillary and mandibular segments, a deep overbite of 4 mm, and a midline deviation of 1.5 mm. The recommended treatment protocol involves comprehensive fixed orthodontic appliance therapy using 0.022-inch slot brackets on all permanent teeth, supplemented by interproximal reduction (IPR) in selected areas and the use of elastics for Class II correction.
The estimated total treatment duration is between 24 and 30 months, with bi-weekly adjustment appointments. All appointments will be conducted at our Orthodontist office in Buenos Aires, Argentina, and the patient will be required to attend all scheduled visits to ensure optimal treatment progression.
3. Itemized Quotation Estimate – Cost Breakdown
| Item / Service | Description | Quantity | Unit Price (ARS) | Subtotal (ARS) |
|---|---|---|---|---|
| Initial Consultation & Diagnostics | Clinical exam, panoramic X-ray, cephalometric X-ray, digital scan, treatment planning | 1 | 45,000 | 45,000 |
| Fixed Orthodontic Brackets (0.022") | 28 brackets (14 maxillary + 14 mandibular), premium ceramic/aesthetic type | 28 | 8,500 | 238,000 |
| Archwires & Ligatures | Complete set of NiTi, stainless steel, and beta-titanium wires with elastic ligatures | 1 | 65,000 | 65,000 |
| Interproximal Reduction (IPR) | Stripping of selected contacts for space creation (up to 12 surfaces) | 12 | 3,500 | 42,000 |
| Class II Elastics & Auxiliary Appliances | Full set of elastics, power chains, and any necessary auxiliary devices | 1 | 28,000 | 28,000 |
| Monthly Adjustment Appointments | Bi-weekly visits for wire changes, bracket adjustments, and progress monitoring (28 months) | 56 | 12,000 | 672,000 |
| Debonding & Finishing | Removal of all brackets, polishing, and final occlusal adjustment | 1 | 55,000 | 55,000 |
| Retainers (Hawley or Essix) | Upper and lower retainers, including one replacement within 12 months | 2 | 35,000 | 70,000 |
| Post-Treatment Follow-Up | Three control visits at 3, 6, and 12 months post-debonding | 3 | 10,000 | 30,000 |
| TOTAL ESTIMATED COST (ARS) | 1,250,000 | |||
4. Payment Terms and Conditions
This Quotation Estimate is denominated in Argentine Pesos (ARS) and is subject to the economic conditions prevailing in Buenos Aires, Argentina, at the time of service delivery. The patient may choose from the following payment options:
- Full Payment: 10% discount applied to the total Quotation Estimate amount, payable upon signing the treatment agreement.
- Installment Plan (24 months): 5% initial down payment, followed by 23 equal monthly installments. No additional interest is charged.
- Installment Plan (36 months): 10% initial down payment, followed by 35 equal monthly installments. A 5% administrative surcharge applies.
Payments may be made via bank transfer (CBU/CVU), credit card (Visa, Mastercard, American Express), or in cash at our Buenos Aires, Argentina office. All payments will be documented with an official Argentine fiscal receipt (factura) in compliance with AFIP regulations.
5. Validity and General Conditions
Important Notice: This Quotation Estimate is valid for 30 calendar days from the date of issue. Due to the fluctuating exchange rates and import costs of orthodontic materials in Argentina, prices may be subject to adjustment after the validity period expires. The final cost may vary by up to 10% depending on the clinical evolution of the treatment. This Quotation Estimate does not include emergency dental procedures, periodontal treatment, or any pre-orthodontic surgical intervention that may be required.The patient acknowledges that the treatment plan described in this Quotation Estimate is based on the clinical findings at the time of the initial consultation. The Orthodontist reserves the right to modify the treatment protocol if clinical conditions change during the course of therapy. Any such modifications will be communicated in writing and a revised Quotation Estimate will be issued accordingly.
All services rendered by this Orthodontist practice in Buenos Aires, Argentina, are covered by the professional liability insurance policy held by Dr. Mariana López. The patient's personal data will be treated in strict accordance with Argentine Law 25,326 on Personal Data Protection (Ley de Protección de Datos Personales).
6. Acceptance
By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed orthodontic treatment plan, and agrees to the financial terms outlined in this document. The Orthodontist confirms that all information provided is accurate and that the services described will be performed in full compliance with Argentine dental practice standards.
Patient SignatureName: _________________________
DNI: _________________________
Date: _________________________ Orthodontist – Dr. Mariana López
Matricula: 45678/BA
Buenos Aires, Argentina
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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