Quotation Estimate Orthodontist in Colombia Medellín –Free Word Template Download with AI

Quotation No.: QTE-MDE-2025-0487
Date Issued: June 12, 2025
Valid Until: July 12, 2025 Prepared By: Dr. Carolina Restrepo, DDS, MSc
Specialty: Orthodontist — Board Certified
Location: Calle 43 # 43A-15, El Poblado, Medellín, Colombia Client Name: [Patient Full Name]
Cédula / ID: [Document Number]
Contact: [Phone / Email]

1. Purpose of This Quotation Estimate

This Quotation Estimate document has been prepared by our licensed Orthodontist practice located in the heart of Colombia Medellín, specifically in the El Poblado district, to provide a comprehensive and transparent financial breakdown of the orthodontic treatment plan recommended for the patient identified above. As a specialized Orthodontist clinic operating under the regulatory standards of the Colombian Ministry of Health (Ministerio de Salud y Protección Social), we are committed to delivering the highest quality of care while ensuring full financial transparency. This Quotation Estimate serves as a formal, non-binding proposal that outlines all anticipated costs, treatment phases, and associated services for the duration of the orthodontic intervention.

2. Clinical Assessment Summary

Following a thorough clinical examination, panoramic radiography (OPG), intraoral digital scanning, and cephalometric analysis conducted by our senior Orthodontist in our Medellín, Colombia facility, the following diagnosis has been established: Class II malocclusion with moderate crowding in the anterior maxillary segment, a 4mm overjet, and a mild crossbite on the left posterior quadrant. The recommended treatment protocol involves fixed orthodontic appliances combined with targeted extractions and a retention phase. All diagnostic imaging and records were obtained at our clinic in Colombia Medellín, and the treatment plan has been designed to achieve optimal occlusal harmony, facial aesthetics, and long-term dental stability.

3. Detailed Cost Breakdown

Item / Service	Description	Quantity	Unit Price (COP)	Subtotal (COP)
Initial Consultation & Diagnostics	Comprehensive exam, OPG, CBCT, intraoral scan, photos, treatment planning by Orthodontist	1	450,000	450,000
Extractions (2 premolars)	Surgical removal of #14 and #24 with local anesthesia, post-op care included	2	380,000	760,000
Fixed Orthodontic Appliance (Braces)	Self-ligating ceramic brackets, archwires, ligatures, bonding & debonding	1	4,200,000	4,200,000
Monthly Adjustments	Orthodontist adjustment visits, wire changes, elastic replacements (18-month treatment)	18	180,000	3,240,000
Interproximal Reduction (IPR)	Strategic enamel reduction for space creation, performed by Orthodontist	1	350,000	350,000
Retainers (Hawley + Clear)	Upper and lower Hawley retainers plus one set of clear Essix retainers	1	620,000	620,000
Post-Treatment Follow-Up	6-month and 12-month post-retention check-ups by the Orthodontist	2	120,000	240,000
Emergency Appointments	Up to 2 unplanned visits for bracket repair or wire adjustment	2	150,000	300,000
TOTAL ESTIMATED COST (COP)				10,160,000
TOTAL ESTIMATED COST (USD approx.)				$2,540.00

4. Payment Terms and Conditions

This Quotation Estimate from our Orthodontist practice in Colombia Medellín offers the following payment structures for the patient's convenience:

Option A — Full Payment: 10% discount applied upon full settlement prior to the initiation of treatment. Total payable: COP 9,144,000.
Option B — Installment Plan: 30% down payment at appliance placement, followed by 18 equal monthly installments of COP 470,000. No interest charged.
Option C — Credit Card: Accepts major international and Colombian credit cards (Visa, Mastercard, American Express, Nacionales). Installments of up to 12 months available through the card issuer.

5. Scope of Practice and Professional Credentials

The treating Orthodontist, Dr. Carolina Restrepo, holds a Master's degree in Orthodontics from the Universidad de Antioquia in Medellín, Colombia, and is a certified member of the Colombian Association of Orthodontists (Asocort). All procedures outlined in this Quotation Estimate will be performed in strict compliance with the sanitary regulations established by the Secretaría de Salud de Medellín and the national health authority. Our clinic in Colombia Medellín is fully equipped with digital imaging, 3D treatment simulation software, and sterilization protocols that meet international ISO standards.

6. Validity, Acceptance, and Disclaimers

This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. Prices are quoted in Colombian Pesos (COP) and are subject to adjustment in the event of significant fluctuations in the exchange rate or changes in the cost of orthodontic materials imported to Colombia. The final treatment duration may vary by up to three months depending on the patient's biological response to orthodontic forces. This document does not constitute a binding contract until signed and countersigned by both parties. Any additional procedures not foreseen during treatment (e.g., periodontal intervention, restorative work) will be quoted separately with prior written consent from the patient.

Important Note: This Quotation Estimate is specific to the Orthodontist services rendered at our clinic in Colombia Medellín. It does not cover general dental services, oral surgery beyond the listed extractions, or emergency care outside of the two included appointments. For any questions regarding this estimate, please contact our front desk at +57 (604) 444-5566 or email [email protected].

7. Acceptance

By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the proposed Orthodontist treatment plan, and agrees to the payment terms outlined herein. The treating Orthodontist confirms that all information provided is accurate and that the treatment plan has been explained in full detail during the initial consultation in Medellín, Colombia.

Patient Signature
Name: ______________________________
Date: ______________________________ Orthodontist / Authorized Representative
Dr. Carolina Restrepo, DDS, MSc
Medellín Smile Orthodontics & Dental Center
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX

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