Quotation Estimate Orthodontist in Bangladesh Dhaka –Free Word Template Download with AI
Professional Orthodontist Services — Bangladesh Dhaka
Ref: QTE-2025-0847 | Valid: 30 DaysProvider Details
Dhaka Smile Orthodontic Centre
House 42, Road 11, Banani, Dhaka-1213
Bangladesh
Tel: +880-2-988-4521
Email: [email protected]
Reg. No: BDMC-ORTHO-2019-0342
Client Details
Mr. Rafiq Ahmed
Flat 7B, Gulshan Avenue, Block C
Gulshan-2, Dhaka-1212
Bangladesh
Tel: +880-1711-556-789
Email: [email protected]
This Quotation Estimate is issued by Dhaka Smile Orthodontic Centre, a licensed and accredited Orthodontist practice operating in Bangladesh Dhaka, to provide the client with a comprehensive, itemised financial breakdown of the proposed orthodontic treatment plan. This document serves as a formal estimate of costs associated with the complete orthodontic correction procedure, including all diagnostic assessments, appliance fabrication, clinical sessions, and follow-up care. The Orthodontist team at our Bangladesh Dhaka facility has prepared this Quotation Estimate following a thorough clinical examination and radiographic analysis conducted on 12 June 2025.
Following a comprehensive evaluation by our senior Orthodontist, Dr. Nusrat Jahan (BDS, MDS in Orthodontics, FICO), the following diagnosis has been established: Class II Division 1 malocclusion with moderate crowding in the maxillary and mandibular arches, a 4 mm overjet, and a 3 mm anterior open bite. The recommended treatment protocol involves fixed orthodontic appliance therapy with a duration of approximately 24 to 30 months, supplemented by periodic adjustments and post-treatment retention. This Quotation Estimate reflects the full scope of services required to achieve optimal occlusal correction within the Bangladesh Dhaka metropolitan area.
| Sr. No. | Service / Item Description | Quantity | Unit Price (BDT) | Amount (BDT) |
|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Records (Panoramic X-ray, Cephalometric X-ray, Intraoral Photographs, Digital Impressions) | 1 | 8,500 | 8,500 |
| 2 | Treatment Planning & Model Analysis by Senior Orthodontist | 1 | 5,000 | 5,000 |
| 3 | Fixed Metal Braces (Upper & Lower Arch) — Material & Bonding | 1 | 65,000 | 65,000 |
| 4 | Monthly Adjustment & Monitoring Sessions (28 sessions over 28 months) | 28 | 3,500 | 98,000 |
| 5 | Interproximal Reduction (IPR) & Minor Tooth Contouring | 1 | 12,000 | 12,000 |
| 6 | Elastics & Auxiliary Appliances (Monthly Supply, 28 months) | 28 | 800 | 22,400 |
| 7 | Debonding, Finishing & Polishing (Upper & Lower) | 1 | 10,000 | 10,000 |
| 8 | Fixed Retainer (Upper & Lower) & Removable Retainer (2 sets) | 1 | 18,000 | 18,000 |
| 9 | Post-Treatment Follow-Up Visits (6 months, 12 months, 18 months, 24 months) | 4 | 2,500 | 10,000 |
| 10 | Emergency Appointments & Bracket Re-bonding (Estimated allowance) | 3 | 2,000 | 6,000 |
| Subtotal | 254,900 | |||
| VAT (5% as per Bangladesh National Board of Revenue) | 12,745 | |||
| Grand Total (BDT) | 267,645 | |||
This Quotation Estimate from our Orthodontist practice in Bangladesh Dhaka offers the following payment structure to facilitate the client's financial planning:
- Initial Deposit (upon acceptance): BDT 50,000 (approximately 18.7% of total)
- Monthly Installment: BDT 8,500 per month for 28 months
- Final Settlement (upon debonding): BDT 15,000
Payments may be made via bank transfer to Dhaka Smile Orthodontic Centre, Sonali Bank, Banani Branch, Dhaka, Bangladesh, or through bKash/Nagad mobile payment. A receipt will be issued for every transaction in accordance with Bangladesh tax regulations.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Beyond this period, the Orthodontist team reserves the right to revise pricing due to changes in material costs or exchange rates applicable in Bangladesh Dhaka.
- The estimated treatment duration of 24 to 30 months is a clinical projection. Actual duration may vary based on individual biological response, patient compliance with elastics wear, and any unforeseen complications identified during the course of treatment.
- All orthodontic procedures will be performed by a qualified Orthodontist or under the direct supervision of the treating Orthodontist at our Bangladesh Dhaka clinic. Assistants and dental hygienists will support routine cleaning and monitoring tasks.
- The client is expected to attend all scheduled appointments. Missed appointments beyond two consecutive sessions may result in a rescheduling fee of BDT 1,500 per occurrence.
- Any additional procedures not included in this Quotation Estimate (e.g., extraction of premolars, orthognathic surgery referral, or treatment of periodontal conditions) will be quoted separately with prior written consent from the client.
- Warranty on fixed retainers is valid for twelve (12) months from the date of placement. Breakage due to trauma or non-compliance with dietary restrictions will be charged at BDT 5,000 per arch.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. The Orthodontist will use best clinical judgement in line with international standards of orthodontic care practised in Bangladesh Dhaka.
- Confidentiality of all patient records, radiographs, and treatment data is maintained in strict compliance with the Bangladesh Medical Association code of ethics and applicable data protection guidelines.
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed orthodontic treatment plan, and authorises the Orthodontist team at Dhaka Smile Orthodontic Centre, Bangladesh Dhaka, to commence treatment upon receipt of the initial deposit.
Client Signature & DateName: Mr. Rafiq Ahmed
Orthodontist / Authorised SignatoryDr. Nusrat Jahan, MDS (Ortho)
Dhaka Smile Orthodontic Centre, Bangladesh Dhaka
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