Quotation Estimate Orthodontist in Brazil São Paulo –Free Word Template Download with AI

This Quotation Estimate is issued by the undersigned Orthodontist, Dr. Helena Martins, operating from her clinic in Brazil São Paulo, to provide the client with a comprehensive, itemized breakdown of all anticipated costs associated with a full orthodontic treatment plan. This document serves as a formal financial projection and does not constitute a binding contract until both parties have signed and accepted the terms outlined herein. All pricing reflects current market rates for orthodontic services in the metropolitan region of São Paulo, Brazil, as of the date of issue.

The following Orthodontist services have been recommended following a complete clinical evaluation, panoramic radiograph (OPG), cephalometric analysis, intraoral photography, and digital impression scan performed on 02 June 2025 at the clinic located in the Bela Vista district of Brazil São Paulo:

This Quotation Estimate allows the client to settle the total amount of R$ 13,720.00 (thirteen thousand seven hundred and twenty Brazilian Reais) according to the following schedule, which is standard practice for orthodontic treatment in Brazil São Paulo:

• Down Payment (upon signing): R$ 3,680.00 (26.8%) — covers initial consultation, diagnostic workup, and bracket fabrication.
• Monthly Installments (24 months): R$ 425.00 per month — covers adjustment visits, consumables, and ongoing Orthodontist supervision.
• Final Payment (at debonding): R$ 1,100.00 — covers debonding, finishing, and retainer fabrication.

Accepted payment methods include bank transfer (TED/PIX), credit card (up to 12 installments with interest), and debit card. A 2% discount applies to full payment via PIX at the time of each scheduled installment.

1. This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After this period, prices may be adjusted to reflect changes in material costs, labor rates, or regulatory updates applicable to the Orthodontist profession in the state of São Paulo, Brazil.
2. The total treatment duration is estimated at twenty-four (24) months. The actual timeline may vary by ±3 months depending on individual biological response, patient compliance, and any unforeseen clinical adjustments the Orthodontist may deem necessary.
3. All services are performed in compliance with the Brazilian Federal Council of Dentistry (CFO) regulations and the specific norms of the São Paulo State Council of Dentistry (CRO-SP).
4. The client agrees to attend all scheduled appointments. Missed appointments without 48-hour prior notice will be subject to a rescheduling fee of R$ 150.00.
5. In the event of early treatment termination at the client's request, a proportional fee for unused months will be refunded, less a 10% administrative deduction.
6. This Quotation Estimate does not include emergency dental care, periodontal treatment, endodontic procedures, or surgical interventions, which will be quoted separately if required.
7. Confidentiality of all clinical records and patient data is guaranteed in accordance with Brazil's General Data Protection Law (LGPD — Lei Geral de Proteção de Dados, Law No. 13.709/2018).
8. Any dispute arising from this agreement shall be subject to the jurisdiction of the courts in Brazil São Paulo, Capital, with the parties agreeing to attempt mediation before judicial proceedings.

By signing below, both parties acknowledge that they have read, understood, and agree to all terms set forth in this Quotation Estimate for Orthodontist services to be rendered in Brazil São Paulo.