Quotation Estimate Orthodontist in Colombia Bogotá –Free Word Template Download with AI
NIT: 901.234.567-8 | RUT: 901.234.567-8 | Phone: +57 (601) 743-2890 | Email: [email protected]
Quotation EstimateQuotation Details
Quotation No.: QE-2025-04871
Date of Issue: June 12, 2025
Valid Until: July 12, 2025 (30 calendar days)
Prepared By: Dr. Mariana Restrepo, DDS, MSc in Orthodontics
Location: Bogotá D.C., Colombia
Client Information
Client Name: [Full Name of Patient]
Document (Cédula): [ID Number]
Address: [Street, Neighborhood], Bogotá D.C., Colombia
Phone: +57 (300) [XXXXXXX]
Email: [[email protected]]
Health Plan (EPS/Compañía): [Name of insurer]
Dear Valued Client,
Thank you for selecting Clínica Ortodóntica Bogotá Premium for your orthodontic care. This Quotation Estimate has been prepared following a comprehensive clinical evaluation conducted by our lead Orthodontist in our Bogotá D.C. facility. The assessment included a full intraoral examination, panoramic radiography (OPG), cephalometric analysis, digital impressions, and a periodontal screening. Based on these findings, the following treatment plan and cost breakdown are presented for your review and approval. All prices are quoted in Colombian Pesos (COP) and reflect the current 2025 fee schedule for orthodontic services in the Bogotá metropolitan area.
| No. | Service / Procedure Description | Quantity | Unit Price (COP) | Subtotal (COP) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Diagnostic Study (includes OPG, cephalometric X-ray, intraoral photographs, digital scan, and treatment plan presentation) | 1 | $480,000 | $480,000 |
| 2 | Periodontal Scaling & Root Planing (full mouth, prerequisite for orthodontic treatment) | 1 | $320,000 | $320,000 |
| 3 | Removal of 4 Premolars (bilateral, upper and lower) with sutures | 4 | $285,000 | $1,140,000 |
| 4 | Placement of Self-Ligating Ceramic Braces (full arch, upper and lower) including bonding, archwire insertion, and elastic ligation | 1 | $4,850,000 | $4,850,000 |
| 5 | Monthly Orthodontic Adjustment Visits (archwire changes, elastic adjustments, bracket re-bonding if needed) — estimated 22 months of treatment | 22 | $185,000 | $4,070,000 |
| 6 | Interproximal Reduction (IPR) — selective enamel stripping for space creation | 1 | $350,000 | $350,000 |
| 7 | Placement of Fixed Retainers (upper and lower anterior segments) with composite resin | 2 | $220,000 | $440,000 |
| 8 | Removable Retainers (Hawley type, upper and lower) with acrylic base and wire | 2 | $380,000 | $760,000 |
| 9 | Final Radiographic Control (OPG + periapical films) and post-treatment documentation | 1 | $290,000 | $290,000 |
| 10 | Emergency Orthodontic Appointments (broken bracket, wire irritation) — included up to 3 visits | 3 | $120,000 | $360,000 |
| SUBTOTAL (COP): | $13,060,000 | |||
| IVA 19% (Colombian Value Added Tax): | $2,481,400 | |||
| TOTAL QUOTATION ESTIMATE (COP): | $15,541,400 | |||
- Down Payment: A non-refundable deposit of 30% (COP $4,662,420) is required to secure your appointment slot and initiate the orthodontic treatment plan. This payment is due upon acceptance of this Quotation Estimate.
- Installment Plan: The remaining balance may be paid in 22 equal monthly installments of COP $512,560, aligned with each monthly adjustment visit. Payments are due on or before the day of each scheduled appointment.
- Accepted Payment Methods: Cash, debit/credit card (Visa, Mastercard, American Express), bank transfer to our Bogotá D.C. account (Bancolombia, Account No. 001-456-7890-11), or through our online payment portal. No additional surcharge applies for card payments.
- Health Plan Coordination: If your EPS or complementary health insurance (e.g., Sanitas, Sura, Colpatria) covers a portion of orthodontic services, our billing team in Bogotá will process the pre-authorization and direct billing on your behalf. The client is responsible for any co-pay or non-covered amounts.
- Quotation Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue. Prices are subject to adjustment based on the Colombian Consumer Price Index (IPC) published by DANE if the validity period is exceeded.
This Quotation Estimate covers the complete orthodontic treatment as described above, performed by a board-certified Orthodontist and supported by a dedicated dental hygienist and dental assistant at our Bogotá D.C. clinic. The estimated treatment duration is 20 to 24 months, subject to individual biological response. Should additional procedures become clinically necessary (e.g., orthognathic surgery referral, additional extractions, or extended retention), a supplementary Quotation Estimate will be issued and require your written consent before any further intervention. All orthodontic appliances used are FDA-cleared and CE-marked materials sourced from internationally recognized manufacturers. Our clinic operates in full compliance with the regulations established by the Colombian Ministry of Health and Social Welfare (Ministerio de Salud y Protección Social) and the Bogotá D.C. local health authority (Secretaría de Salud Distrital).
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed orthodontic treatment plan, and authorizes the Orthodontist and clinical team at Clínica Ortodóntica Bogotá Premium to proceed with the services described herein. The client agrees to the payment terms, cancellation policy (a 15% administrative fee applies if cancellation occurs after the down payment), and the clinical disclaimers outlined in the full informed consent form provided separately.
Client Signature[Full Name] — C.C. [Number]
Date: _______________ Orthodontist / Authorized Representative
Dr. Mariana Restrepo, DDS, MSc
Clínica Ortodóntica Bogotá Premium
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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