Quotation Estimate Orthodontist in Canada Vancouver –Free Word Template Download with AI
1280 West Georgia Street, Suite 450, Vancouver, British Columbia, Canada V6E 1Y2
Phone: (604) 555-0198 | Email: [email protected]
Regulated by the College of Denturists of British Columbia | License No. BC-ORTHO-2019-4471
Orthodontist – Canada Vancouver Quotation EstimatePrepared For
Client Name: Alexandra M. Thompson
Address: 742 Oakridge Avenue, Unit 1203, Vancouver, BC, Canada V6B 3K4
Phone: (604) 555-7723
Email: [email protected]
Quotation Details
Quotation No.: QE-2025-04872
Date Issued: June 14, 2025
Valid Until: July 14, 2025
Prepared By: Dr. James K. Whitfield, Orthodontist
Referral Source: Dr. Susan Park, General Dentist
Dear Ms. Thompson,
Thank you for choosing Coastal Smile Orthodontics, a trusted Orthodontist practice serving the greater Canada Vancouver metropolitan area. Following your comprehensive consultation and diagnostic imaging on June 10, 2025, this Quotation Estimate outlines the full scope of orthodontic treatment recommended for your case. As a licensed Orthodontist operating in Canada Vancouver, we are committed to providing transparent, itemized pricing so that you may make an informed decision regarding your smile correction journey.
| # | Service / Procedure | Description | Qty | Unit Price (CAD) |
|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Workup | Comprehensive examination, panoramic X-ray, cephalometric radiograph, intraoral photographs, and digital 3D scan | 1 | $285.00 |
| 2 | Orthodontic Treatment Plan Development | Custom treatment plan by the Orthodontist, including digital simulation of projected outcomes | 1 | $150.00 |
| 3 | Pre-Orthodontic Extractions | Removal of four (4) premolars (upper and lower) to create space for alignment | 4 | $120.00 |
| 4 | Custom Ceramic Braces – Upper Arch | Placement of tooth-coloured ceramic brackets and archwire on upper dentition | 1 | $2,450.00 |
| 5 | Custom Ceramic Braces – Lower Arch | Placement of tooth-coloured ceramic brackets and archwire on lower dentition | 1 | $2,450.00 |
| 6 | Monthly Adjustment Visits | Archwire changes, elastic adjustments, and progress monitoring by the Orthodontist (estimated 18 months) | 18 | $95.00 |
| 7 | Interproximal Reduction (IPR) | Minor enamel reshaping between teeth to resolve crowding (as needed during treatment) | 1 | $320.00 |
| 8 | Removable Retainers (Upper & Lower) | Two (2) custom-fabricated Essix retainers to maintain post-treatment alignment | 2 | $210.00 |
| 9 | Post-Treatment Follow-Up Visits | Three (3) check-up appointments at 6, 12, and 24 months post-debonding | 3 | $75.00 |
| 10 | Emergency / Breakage Repairs | Up to two (2) complimentary repairs of brackets or wires during active treatment | 2 | $0.00 |
| Subtotal | $10,170.00 |
| BC Health Services Authority (BCBSA) Reimbursement (Est.) | -$1,425.00 |
| Goods and Services Tax (GST) 5% | $457.50 |
| Harmonized Sales Tax (HST) 5% (BC) | $457.50 |
| Estimated Total (CAD) | $9,659.00 |
Terms & Conditions of This Quotation Estimate
- This Quotation Estimate is valid for thirty (30) days from the date of issue. Pricing is subject to change after the validity period due to material cost fluctuations in the Canada Vancouver dental supply market.
- All fees are quoted in Canadian Dollars (CAD) and are payable to Coastal Smile Orthodontics, a registered Orthodontist practice in Vancouver, British Columbia, Canada.
- A deposit of 20% ($1,931.80) is required at the time of acceptance to reserve your treatment slot with our Orthodontist. The remaining balance may be paid in monthly installments over the duration of active treatment.
- Payment plans are available through our in-house financing partner, SmileCare Financial (BC), offering 0% interest over 18 months for qualified applicants residing in Canada Vancouver.
- BCBSA reimbursement estimates are based on current 2025 fee schedules. Actual reimbursement amounts are determined by your specific insurance plan and may vary. This Quotation Estimate does not guarantee insurance coverage.
- Treatment duration is estimated at 18 months. The Orthodontist reserves the right to extend or modify the treatment plan based on clinical progress. Additional visits beyond the estimated 18 will be billed at the standard adjustment rate of $95.00 per visit.
- Any additional procedures not listed in this Quotation Estimate (e.g., orthognathic surgery referral, additional extractions, or appliance replacements due to patient negligence) will be quoted separately in writing prior to commencement.
- This Quotation Estimate is a good-faith estimate and does not constitute a binding contract until signed and accepted by both parties. By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined herein.
- Coastal Smile Orthodontics complies with all regulations set forth by the College of Denturists of British Columbia and the Canadian Dental Association. Our Orthodontist, Dr. James K. Whitfield, holds a Doctor of Dental Surgery (DDS) degree and a Master's in Orthodontics from the University of British Columbia.
- For any questions regarding this Quotation Estimate, please contact our office at (604) 555-0198 or visit us at 1280 West Georgia Street, Vancouver, Canada. We are open Monday through Friday, 8:00 AM to 6:00 PM, and Saturday 9:00 AM to 2:00 PM.
Coastal Smile Orthodontics – Canada Vancouver
Date: ______________________ Client Acceptance
Alexandra M. Thompson
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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