Quotation Estimate Orthodontist in China Shanghai –Free Word Template Download with AI
Orthodontist Professional Services
Shanghai, China | PRC
Document Ref: QTE-SH-2025-0487This Quotation Estimate is issued by Shanghai Jing'an Orthodontic Centre, a licensed and accredited dental practice operating in the Jing'an District of China Shanghai. The purpose of this document is to provide a comprehensive, itemised cost breakdown for the full course of orthodontic treatment to be performed by our senior Orthodontist team. All pricing is quoted in Chinese Yuan (CNY / RMB) and reflects the current fee schedule as of the date of issue.
Our Orthodontist, Dr. Wei Zhang, holds a Doctorate in Clinical Orthodontics from Fudan University and has over fifteen years of specialised experience in comprehensive orthodontic care. The treatment plan outlined in this Quotation Estimate has been developed following a full clinical examination, digital intraoral scanning, panoramic radiography (OPG), and cephalometric analysis conducted on 10 June 2025 at our clinic located at 888 Nanjing West Road, Jing'an District, Shanghai, China.
| Item No. | Description of Service | Frequency / Duration | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 01 | Initial Consultation & Diagnostic Workup (Digital Scan, OPG X-ray, Cephalometric Analysis, Clinical Photographs) | One-time | 1,200.00 | 1,200.00 |
| 02 | Customised Treatment Plan Design & Digital Simulation (3D Smile Preview) | One-time | 800.00 | 800.00 |
| 03 | Placement of Self-Ligating Ceramic Brackets (Upper & Lower Arch, 28 brackets total) | One-time | 18,000.00 | 18,000.00 |
| 04 | Archwire Fitting, Ligature Changes & Routine Orthodontic Adjustments | Every 6 weeks × 18 visits | 600.00 | 10,800.00 |
| 05 | Interproximal Reduction (IPR) / Enamel Stripping (as clinically indicated) | As required (est. 4 sessions) | 400.00 | 1,600.00 |
| 06 | Orthodontic Elastics & Auxiliary Appliances (Monthly Supply) | 18 months | 150.00 | 2,700.00 |
| 07 | Debonding, Finishing & Polishing (Removal of all brackets and wires) | One-time | 2,500.00 | 2,500.00 |
| 08 | Fixed Retainer Fabrication & Bonding (Upper & Lower, 3-month bond) | One-time | 3,000.00 | 3,000.00 |
| 09 | Removable Retainer (Essix / Vivera) – Two Sets (Upper & Lower) | One-time | 2,800.00 | 2,800.00 |
| 10 | Post-Treatment Follow-Up Reviews (Months 1, 3, 6, 12, 18, 24) | 6 visits | 300.00 | 1,800.00 |
| 11 | Emergency / Breakage Repair (Included up to 3 incidents during treatment) | As needed | 500.00 | 1,500.00 |
| GRAND TOTAL (Inclusive of all listed services) | ¥ 47,700.00 | |||
In accordance with the standard billing policy of our Orthodontist practice in China Shanghai, the total Quotation Estimate amount of ¥47,700.00 may be settled through the following payment plan:
| Installment | Due Date | Amount (CNY) |
|---|---|---|
| Deposit (upon acceptance of this Quotation Estimate) | 15 June 2025 | ¥ 10,000.00 |
| Second Payment (at bracket placement) | 1 July 2025 | ¥ 15,000.00 |
| Third Payment (mid-treatment, approx. Month 9) | March 2026 | ¥ 12,000.00 |
| Final Payment (at debonding) | December 2026 | ¥ 10,700.00 |
4.1 This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be subject to revision based on material cost fluctuations and updated fee schedules in China Shanghai.
4.2 The total treatment duration is estimated at eighteen (18) to twenty-four (24) months, depending on individual biological response. The Orthodontist reserves the right to extend or modify the treatment plan if clinical progress deviates from the projected timeline.
4.3 All services are performed in strict compliance with the National Health Commission of the People's Republic of China regulations and the Shanghai Municipal Medical Practice Standards. Our clinic holds a valid Medical Institution Practicing License (No. PDY104823731010217D1501).
4.4 The patient is responsible for maintaining oral hygiene and attending all scheduled Orthodontist appointments. Missed appointments exceeding two consecutive visits may result in a rescheduling fee of ¥200.00 per occurrence.
4.5 Any additional procedures not listed in this Quotation Estimate (e.g., extraction of supernumerary teeth, periodontal intervention, or orthognathic referral) will be quoted separately in writing prior to execution.
4.6 Payment may be made via bank transfer, Alipay, WeChat Pay, or major credit cards. A receipt will be issued for every transaction in accordance with Chinese tax regulations.
4.7 This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. The Orthodontist will use best clinical judgement to achieve the optimal functional and cosmetic result within the parameters of the patient's anatomy.
By signing below, the patient (or legal guardian) acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed orthodontic treatment plan, and authorises the Orthodontist at Shanghai Jing'an Orthodontic Centre to commence the services described herein.
Patient / Legal GuardianName: ______________________
Date: ______________________ Orthodontist – Dr. Wei Zhang
Shanghai Jing'an Orthodontic Centre
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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