Quotation Estimate Orthodontist in France Paris –Free Word Template Download with AI

Following a comprehensive clinical examination and radiographic analysis (panoramic X-ray, cephalometric tracing, and intraoral digital impressions) conducted on 10 June 2025 at our Orthodontist practice in the 8th arrondissement of Paris, France, the following diagnosis has been established for Mr. James A. Whitfield, aged 34 years:

• Class II malocclusion with a 6 mm overjet
• Moderate crowding in the upper and lower anterior segments (approximately 4 mm)
• Mild midline deviation of the lower dental arch
• Normal periodontal health confirmed by periodontal screening
• No contraindications to fixed orthodontic appliance therapy

This Quotation Estimate has been prepared by the treating Orthodontist to provide a transparent and detailed financial breakdown of the recommended treatment plan. All pricing reflects current 2025 fee schedules applicable to private orthodontic practices in France Paris and the Île-de-France region.

This Quotation Estimate is valid for a period of sixty (60) calendar days from the date of issue. The Orthodontist practice reserves the right to revise fees in accordance with any changes to the national fee schedule (Convention Nationale) or local regulatory updates in France Paris.

• Payment Schedule: The total amount of €6,640.00 may be settled in full upon placement of the appliance, or in three equal instalments of €2,213.33 (first instalment due at appliance placement, second at month 6, third at month 12). No interest is charged on instalment plans.
• Accepted Payment Methods: Bank transfer (virement bancaire), credit/debit card (Visa, Mastercard, American Express), or cash. Cheques are accepted only for amounts below €500.00.
• Cancellation Policy: Appointments cancelled with less than 48 hours' notice will be subject to a fee of €50.00. Cancellation of the entire treatment after appliance placement will not be refundable for work already performed.
• Warranty: The Orthodontist guarantees the integrity of all brackets and wires for the duration of active treatment. Accidental damage caused by the patient (e.g., biting hard objects, sports-related trauma) will be billed at the standard re-cementation rate of €60.00 per incident.
• Confidentiality: All patient data is processed in strict compliance with the French Data Protection Act (Loi Informatique et Libertés) and the European General Data Protection Regulation (GDPR). Records are retained for a minimum of ten (10) years as required by French medical law.
• Dispute Resolution: Any disagreement regarding this Quotation Estimate or the treatment provided shall be resolved in accordance with the Code de la Santé Publique. The patient may file a complaint with the Ordre des Médecins, Île-de-France section, or seek mediation through the Commission de Conciliation et de Conciliation Médicale.

By signing below, the patient acknowledges having received and understood this Quotation Estimate for orthodontic treatment. The patient confirms that the Orthodontist has explained the proposed treatment plan, alternative options (including clear aligner therapy and non-treatment), expected duration, and associated risks. The patient authorises the commencement of treatment as described herein.