Quotation Estimate Orthodontist in Canada Toronto –Free Word Template Download with AI
Orthodontic Treatment Services
TORONTO, CANADA
Quotation No: QTE-2025-04871 | Date: June 15, 2025 | Valid Until: July 15, 2025
Provider
Dr. Sarah Mitchell, DDS, Orthodontist
North York Orthodontic Centre
2200 Yonge Street, Suite 450
North York, Toronto, Ontario M4P 1E4
Canada
Phone: (416) 555-0192
Email: [email protected]
Client
Mr. James A. Thompson
1847 Bloor Street West, Unit 312
Toronto, Ontario M6M 3Y8
Canada
Phone: (647) 555-0347
Email: [email protected]
This Quotation Estimate has been prepared by our licensed Orthodontist practice in Toronto, Canada, following a comprehensive clinical examination and diagnostic imaging session conducted on June 10, 2025. The following orthodontic treatment plan has been developed specifically for the client based on the findings of panoramic radiographs, cephalometric analysis, intraoral photographs, and digital impressions. All services are delivered in accordance with the standards set by the College of Dentists of Ontario and the Canadian Association of Orthodontists.
| Item / Service | Description | Qty | Unit Price (CAD) | Subtotal (CAD) |
|---|---|---|---|---|
| Initial Consultation & Examination | Comprehensive orthodontic assessment by Dr. Mitchell, including clinical history review, intraoral examination, and treatment planning discussion. | 1 | $250.00 | $250.00 |
| Diagnostic Imaging & Records | Panoramic X-ray, cephalometric radiograph, intraoral photographs (12 views), and digital 3D scan of dental arches. | 1 | $320.00 | $320.00 |
| Fixed Orthodontic Braces (Ceramic) | Full-arch ceramic bracket system (upper and lower), including bonding, wire adjustments, and elastic placement. Estimated treatment duration: 24 months. | 1 | $6,800.00 | $6,800.00 |
| Monthly Adjustment Visits | Regular orthodontic adjustment appointments every 6–8 weeks for wire changes, bracket repositioning, and progress monitoring. Estimated 28 visits over treatment period. | 28 | $120.00 | $3,360.00 |
| Interproximal Reduction (IPR) | Minimal enamel reduction between teeth to create space for alignment. Estimated 4–6 surfaces. | 1 | $450.00 | $450.00 |
| Removable Retainers (Hawley) | Upper and lower Hawley-type retainers with acrylic base and wire clasps, to be worn post-treatment. | 2 | $275.00 | $550.00 |
| Emergency / Breakage Visits | Up to 3 unplanned visits for bracket debonding, wire repositioning, or appliance repair during active treatment. | 3 | $95.00 | $285.00 |
| Post-Treatment Review | Final de-bonding, polishing, post-orthodontic assessment, and retainer fitting appointment. | 1 | $350.00 | $350.00 |
| Annual Retainer Check-ups | Two (2) annual follow-up visits during the first two years of retention to monitor stability of results. | 2 | $110.00 | $220.00 |
| TOTAL ESTIMATED COST (CAD) | $12,585.00 | |||
| HST (13% – Ontario, Canada) | $1,636.05 | |||
| GRAND TOTAL (CAD) | $14,221.05 | |||
- Deposit: A non-refundable deposit of 20% ($2,517.00 CAD) is required at the time of acceptance of this Quotation Estimate to secure the client's position in the Orthodontist's treatment schedule in Toronto.
- Payment Schedule: The remaining balance shall be paid in equal monthly instalments over the 24-month treatment period. Monthly payment amount: approximately $485.00 CAD (inclusive of HST).
- Accepted Payment Methods: Interac e-Transfer, Visa, Mastercard, American Express, and personal cheques drawn on Canadian financial institutions.
- Insurance: The client is advised to verify orthodontic coverage with their dental insurance provider. This practice in Toronto, Canada, will submit claims directly to the insurer where applicable. Any co-payments or non-covered amounts remain the client's responsibility.
- Validity: This Quotation Estimate is valid for thirty (30) days from the date of issue. Prices are subject to change after the validity period due to material cost fluctuations or practice fee adjustments.
- Cancellation: Should the client withdraw from treatment after the deposit has been paid, the deposit will be forfeited. Cancellation after active treatment has commenced will incur a pro-rated charge for services already rendered.
- Warranty: The Orthodontist guarantees the integrity of all bonded appliances for a period of 12 months from the date of placement, excluding damage caused by patient negligence, trauma, or non-compliance with care instructions.
By signing below, the client acknowledges that they have received, reviewed, and understood this Quotation Estimate for orthodontic services to be performed in Toronto, Canada. The client agrees to the payment terms, treatment duration estimates, and all conditions outlined in this document. The client confirms that the Orthodontist has explained the proposed treatment plan, alternative options, potential risks, and expected outcomes in full.
Client Signature
James A. Thompson
Date: _______________
Orthodontist / Authorized Representative
Dr. Sarah Mitchell, DDS
North York Orthodontic Centre, Toronto, Canada
Date: _______________
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