Quotation Estimate Orthodontist in Australia Brisbane –Free Word Template Download with AI
Level 3, 120 Creek Street, Brisbane City, Queensland 4000, Australia
Phone: (07) 3210 4567 | Email: [email protected]
ABN: 54 123 456 789 | AHPRA Registration: 1234567
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-0847
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Prepared By: Dr. Sarah Mitchell, Orthodontist
Client Details
Name: Mr. James Anderson
Address: 45 Anzac Parade, New Farm, Brisbane, QLD 4005
Phone: 0412 345 678
Email: [email protected]
Health Fund: HCF (Orthodontic Cover: Yes)
This Quotation Estimate has been prepared by our experienced Orthodontist team at Brisbane Smile Orthodontics, a leading orthodontic practice located in the heart of Australia Brisbane. Following a comprehensive clinical examination and digital imaging assessment conducted on 10 June 2025, we are pleased to present the detailed cost breakdown for the recommended orthodontic treatment plan. This Quotation Estimate reflects current Australian pricing standards and includes all professional fees, materials, and scheduled appointments required to achieve optimal dental alignment and occlusal correction.
Itemised Treatment Costs| # | Description of Service | Frequency | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|
| 1 | Initial Consultation, Clinical Examination & Digital Records (X-rays, intraoral scans, photographs) | One-time | $350.00 | $350.00 |
| 2 | Comprehensive Treatment Planning & Digital Simulation (3D treatment preview) | One-time | $200.00 | $200.00 |
| 3 | Custom Ceramic (Tooth-Coloured) Brackets – Full Arch (Upper & Lower) | One-time | $4,800.00 | $4,800.00 |
| 4 | Orthodontic Bonding & Archwire Placement (Initial Setup) | One-time | $650.00 | $650.00 |
| 5 | Monthly Adjustment Appointments (Archwire changes, elastic adjustments, progress monitoring) | 18 months | $185.00 | $3,330.00 |
| 6 | Interproximal Reduction (IPR) – Selective Enamel Resurfacing | As required | $120.00 | $240.00 |
| 7 | Debonding & Finishing (Bracket removal, polishing, occlusal adjustment) | One-time | $450.00 | $450.00 |
| 8 | Custom Removable Retainers (Upper & Lower – Essix type) | One-time | $550.00 | $550.00 |
| 9 | Retainer Review & Adjustment Appointments (Post-treatment monitoring) | 3 visits (6, 12, 24 months) | $120.00 | $360.00 |
| 10 | Emergency/Extra Appointments (If required during treatment) | Up to 2 visits | $150.00 | $300.00 |
| Subtotal (AUD) | $11,230.00 | |||
| Estimated Health Fund Rebate (HCF – Orthodontic) | -$2,500.00 | |||
| Patient Out-of-Pocket Balance (AUD) | $8,730.00 | |||
This Quotation Estimate offers flexible payment options to suit your financial circumstances. As a registered Orthodontist practice in Australia Brisbane, we are committed to making quality orthodontic care accessible. The following payment plan is available:
| Payment | Due Date | Amount (AUD) |
|---|---|---|
| Deposit (upon acceptance of this Quotation Estimate) | 14 June 2025 | $1,500.00 |
| Monthly Instalments (18 payments) | Monthly from July 2025 | $436.50 |
| Final Balance (upon debonding) | Approx. December 2026 | $0.00 |
1. This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Pricing is subject to change after the validity period expires.
2. All fees are quoted in Australian Dollars (AUD) and are inclusive of GST where applicable. As a registered Orthodontist in Australia Brisbane, our practice complies with all Australian Health Practitioner Regulation Agency (AHPRA) standards and Queensland Health regulations.
3. The estimated treatment duration of eighteen (18) months is based on clinical assessment. Actual treatment time may vary depending on individual response to orthodontic forces. Additional appointments beyond those listed may incur extra charges at the standard consultation rate of $185.00 per visit.
4. Health fund rebates are estimates only and are subject to the terms and conditions of your specific HCF policy. Our practice will submit claims on your behalf, but the final rebate amount is determined solely by your health insurer.
5. A 10% cancellation fee applies to missed appointments not rescheduled at least 48 hours in advance. This Quotation Estimate does not cover pre-existing dental conditions (e.g., fillings, extractions, periodontal treatment) that may need to be addressed prior to or during orthodontic treatment.
6. Retainers must be worn as directed by your Orthodontist. Replacement retainers due to loss or damage will be charged at $275.00 per arch.
7. This Quotation Estimate is non-transferable and is prepared specifically for the named client. It does not constitute a binding contract until signed and returned with the deposit payment.
8. Our practice in Australia Brisbane operates Monday to Friday, 8:30 AM to 5:30 PM, and Saturday 9:00 AM to 1:00 PM. Appointments are scheduled at the convenience of the patient within these hours.
AcceptanceBy signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions outlined above. The client confirms that the recommended orthodontic treatment plan has been explained in full by the treating Orthodontist and that all questions have been satisfactorily answered.
Client Signature: ___________________________Name: James Anderson
Date: _______________ Orthodontist Signature: ___________________________
Dr. Sarah Mitchell, B.Dental, M.Ortho (AUS)
AHPRA Reg. No: 1234567
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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