Quotation Estimate Orthodontist in Australia Sydney –Free Word Template Download with AI
Sydney Orthodontic Centre
Level 5, 128 George Street, Sydney NSW 2000, Australia
ABN: 45 123 456 789 | AHPRA Registration: 10045678923
Phone: +61 2 9234 5678 | Email: [email protected]
Date Issued: 14 June 2025
Valid Until: 14 July 2025 (30 days) Prepared For:
Ms. Sarah Elizabeth Mitchell
42 Harbour View Drive
Mosman, NSW 2088
Australia Sydney
Phone: +61 412 345 678 1. SCOPE OF ORTHODONTIC SERVICES
This Quotation Estimate has been prepared by our registered Orthodontist, Dr. James A. Whitfield (AHPRA Reg. No. 10045678923), following a comprehensive clinical examination and diagnostic assessment conducted on 10 June 2025 at our Australia Sydney practice. The purpose of this document is to provide Ms. Mitchell with a detailed, itemised cost breakdown for the recommended orthodontic treatment plan. All pricing is quoted in Australian Dollars (AUD) and includes Goods and Services Tax (GST) at the current rate of 10%.
2. DIAGNOSTIC ASSESSMENT SUMMARYFollowing a full intraoral examination, panoramic radiograph (OPG), cephalometric analysis, and digital intraoral scanning, the Orthodontist has identified a Class II malocclusion with moderate crowding in the upper and lower anterior segments, a 4mm overjet, and a crossbite on the left posterior segment. The recommended treatment involves fixed appliance therapy (braces) combined with interproximal reduction (IPR) and a subsequent retention phase. The estimated total treatment duration is 24 to 30 months.
3. ITEMISED QUOTATION ESTIMATE| Ref | Description of Orthodontic Service | Frequency / Duration | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|
| 1.1 | Initial Consultation & Diagnostic Records (OPG, cephalometric X-rays, digital impressions, clinical photographs) | One-time | $450.00 | $450.00 |
| 1.2 | Fixed Orthodontic Appliance Placement (metal brackets, upper and lower arches, bonding, archwire insertion) | One-time | $3,200.00 | $3,200.00 |
| 1.3 | Monthly Orthodontic Adjustment Appointments (archwire changes, elastic adjustments, progress monitoring) | 26 months | $185.00 | $4,810.00 |
| 1.4 | Interproximal Reduction (IPR) — selective enamel stripping for space creation | As required (est. 4 sessions) | $120.00 | $480.00 |
| 1.5 | Appliance Removal & Final Impressions for Retention Appliances | One-time | $650.00 | $650.00 |
| 1.6 | Fixed Retainers (upper and lower, bonded behind anterior teeth) & Removable Retainer (Essix type, upper and lower) | One-time | $850.00 | $850.00 |
| 1.7 | Emergency / Breakage Appointments (bracket re-bonding, wire trimming, elastic replacement) | Up to 6 visits | $95.00 | $570.00 |
| 1.8 | Post-Treatment Review & Retainer Check-ups (6-monthly for 2 years) | 4 visits | $110.00 | $440.00 |
| 1.9 | Additional Radiographs or Imaging (if clinically indicated during treatment) | As required (est. 2) | $145.00 | $290.00 |
| SUBTOTAL (GST Inclusive) | $11,740.00 | |||
| ESTIMATED TOTAL — QUOTATION ESTIMATE | $11,740.00 | |||
The Orthodontist at our Australia Sydney practice offers the following payment arrangements to make this Quotation Estimate accessible:
| Option | Details | Cost |
|---|---|---|
| A — Full Payment | 100% of the Quotation Estimate total due at the time of appliance placement. 2% discount applied. | $11,505.20 |
| B — Deposit & Instalments | 20% deposit ($2,348.00) at placement, remainder in 24 equal monthly instalments of $383.00. | $11,740.00 |
| C — Finance via HBF / Medibank / ZipPay | Interest-free or low-interest plans available. Subject to credit approval. Contact our Australia Sydney finance team for details. | Varies |
- This Quotation Estimate is valid for a period of 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, supplier pricing, or Australian regulatory adjustments.
- All fees quoted are in Australian Dollars (AUD) and include GST at 10%. No additional charges will be applied beyond those itemised in this Quotation Estimate unless clinically necessary and communicated in writing to the patient.
- The estimated treatment duration of 24–30 months is a clinical projection. The Orthodontist may adjust the treatment timeline based on individual patient response. Additional adjustment appointments beyond the 26 included will be charged at $185.00 per visit.
- Emergency and breakage appointments are limited to 6 visits as stated. Any further emergency visits will be billed at $95.00 per occurrence.
- Patients are required to attend all scheduled Orthodontist appointments. Missed appointments without 48 hours' notice will incur a $75.00 no-show fee.
- This Quotation Estimate does not include the cost of any pre-existing dental work (fillings, extractions, periodontal treatment) that may be required prior to or during orthodontic treatment. Such procedures will be quoted separately.
- Health Fund rebates: This practice is a registered provider with HBF, Medibank, Bupa, and Health Care Australia. Patients with orthodontic extras cover may be eligible for partial rebates. The patient is responsible for any out-of-pocket balance.
- By accepting this Quotation Estimate, the patient consents to the recommended orthodontic treatment plan and agrees to the terms outlined above. A signed treatment consent form will be provided at the time of appliance placement.
- All clinical records, radiographs, and digital scans are stored in accordance with the Australian Privacy Act 1988 and the Australian Health Privacy Code. The Orthodontist and practice staff are bound by professional confidentiality obligations under the AHPRA National Registration and Accreditation Scheme.
- This Quotation Estimate is issued by a registered Orthodontist practising in Australia Sydney and is governed by the laws of the State of New South Wales, Australia.
To accept this Quotation Estimate, please sign below and return a copy to our Australia Sydney office within the validity period. A 20% deposit is required to secure your treatment start date.
Patient Signature & DateMs. Sarah Elizabeth Mitchell
Orthodontist / Authorising PractitionerDr. James A. Whitfield, AO
AHPRA Reg. No. 10045678923
Sydney Orthodontic Centre, Australia Sydney
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