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Quotation Estimate Orthodontist in China Guangzhou –Free Word Template Download with AI

No. 88 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China 510620

Tel: +86-20-8888-6666 | Email: [email protected]

License No.: GZ-ORTH-2024-00312 | NMPA Registered

Quotation Estimate

Quotation Details

Quotation No.: GZ-ORTH-QE-2025-04187

Date of Issue: 15 June 2025

Valid Until: 15 July 2025 (30 days)

Currency: Chinese Yuan (CNY / RMB)

Prepared By: Dr. Lin Wei, Lead Orthodontist

Client Information

Patient Name: [To be completed]

ID / Passport No.: [To be completed]

Contact Phone: [To be completed]

Address: [To be completed]

Referral Source: [To be completed]

This Quotation Estimate has been prepared by the Guangzhou Pearl River Orthodontic Center to provide a comprehensive and transparent breakdown of anticipated orthodontic treatment costs for the patient identified above. As a licensed Orthodontist practice operating in China Guangzhou, we adhere to the pricing guidelines established by the Guangzhou Municipal Health Commission and the National Medical Products Administration (NMPA). All fees listed below are inclusive of applicable Value Added Tax (VAT) at the standard rate of 6% for medical services in the People's Republic of China. This document serves as a non-binding estimate and does not constitute a final invoice. The actual costs may vary slightly depending on the clinical findings during the full diagnostic examination, the complexity of the malocclusion, and any additional procedures that may become necessary during the course of treatment.

Itemized Treatment Services & Estimated Costs
No. Service / Procedure Description Quantity / Duration Unit Price (CNY) Subtotal (CNY)
1 Initial Consultation & Comprehensive Diagnostic Assessment (including panoramic X-ray, cephalometric radiograph, intraoral photography, and digital study models) 1 session ¥ 800.00 ¥ 800.00
2 Orthodontic Treatment Plan Formulation & Patient Education Session (conducted by the lead Orthodontist) 1 session ¥ 500.00 ¥ 500.00
3 Fixed Metal Braces – Full Arch (Upper & Lower), including bracket bonding, archwire placement, and elastic ligatures 28 teeth ¥ 18,000.00 ¥ 18,000.00
4 Monthly Adjustment & Wire Change Appointments (standard orthodontic follow-up visits) 18 months ¥ 600.00 / month ¥ 10,800.00
5 Removable Retainer Fabrication (Hawley type, upper and lower) – post-debonding phase 2 sets ¥ 1,200.00 / set ¥ 2,400.00
6 Periodontal Screening & Professional Dental Cleaning (prior to orthodontic appliance placement) 1 session ¥ 1,500.00 ¥ 1,500.00
7 Emergency / Unscheduled Adjustment Visit (if required during treatment) Up to 3 visits ¥ 400.00 / visit ¥ 1,200.00
8 Final De-bonding, Polishing & Post-Treatment Radiographic Evaluation 1 session ¥ 1,000.00 ¥ 1,000.00
9 Annual Retainer Check-up (first 2 years post-treatment) 2 years ¥ 300.00 / year ¥ 600.00
TOTAL ESTIMATED COST (Incl. 6% VAT): ¥ 36,800.00
Payment Terms & Schedule

1. A non-refundable deposit of 30% (¥ 11,040.00) of the total Quotation Estimate amount is required at the time of treatment plan acceptance to secure the patient's appointment slot with our Orthodontist team in China Guangzhou.

2. The remaining 70% balance shall be payable in equal monthly installments over the 18-month active treatment period, or in a single lump sum at the commencement of active orthodontic treatment, at the patient's discretion.

3. Accepted payment methods include: UnionPay (银联), Alipay (支付宝), WeChat Pay (微信支付), bank transfer to our registered corporate account, and major international credit cards (Visa, Mastercard) with a 2% surcharge for foreign currency transactions.

4. All payments are subject to the standard financial regulations of the People's Bank of China. Official fiscal receipts (发票) will be issued upon each payment in accordance with Chinese tax law.

Terms, Conditions & Important Notes

1. This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision in accordance with the prevailing medical service fee schedule published by the Guangzhou Municipal Healthcare Security Administration.

2. The estimated treatment duration of 18 months is based on the initial clinical assessment. The treating Orthodontist reserves the right to extend or modify the treatment timeline if clinical progress warrants additional intervention. Any extension beyond the estimated period will be communicated in writing, and a supplementary Quotation Estimate will be issued prior to any additional charges.

3. This estimate does not include the cost of any pre-existing dental restorations (fillings, crowns, root canal treatments) that may need to be addressed before orthodontic treatment can commence. Such procedures will be quoted separately by our general dentistry department.

4. The patient acknowledges that orthodontic treatment outcomes are influenced by compliance with the Orthodontist's instructions, including proper oral hygiene maintenance, dietary restrictions, and attendance at all scheduled appointments. Failure to comply may result in treatment extension and additional costs not covered by this Quotation Estimate.

5. In the event of treatment discontinuation by the patient before the completion of the planned course, the deposit and all payments made to date shall be non-refundable, as the Orthodontist's professional time, materials, and clinical resources will have been allocated and utilized.

6. All clinical records, radiographs, and digital models generated during the course of treatment remain the property of the Guangzhou Pearl River Orthodontic Center. The patient is entitled to a copy of their records upon written request, in compliance with the Personal Information Protection Law of the People's Republic of China (PIPL, effective 1 November 2021).

7. This Quotation Estimate is issued in the English language for the convenience of the patient. In the event of any discrepancy between the English and Chinese versions of this document, the Chinese version shall prevail as the legally binding document under the laws of the People's Republic of China.

8. The practice is fully insured under the Medical Malpractice Liability Insurance policy held with Ping An Insurance (Group) Company of China, Limited, Policy No. PA-2025-GZ-77421, with a coverage limit of ¥ 5,000,000 per incident.

Prepared & Authorized By:
Dr. Lin Wei, DDS, MSc (Orthodontics)
Lead Orthodontist, Guangzhou Pearl River Orthodontic Center
Medical Practitioner License: GZ-2019-004521
Patient / Guardian Acknowledgment:
I have read and understood this Quotation Estimate.
Signature: _________________________
Date: _________________________

Guangzhou Pearl River Orthodontic Center | No. 88 Tianhe Road, Tianhe District, Guangzhou, Guangdong, China 510620

This Quotation Estimate document is generated electronically and is valid without a physical seal. For verification, please contact our front desk at +86-20-8888-6666.

© 2025 Guangzhou Pearl River Orthodontic Center. All rights reserved. | ICP License: 粤ICP备2024001234号

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