Quotation Estimate Orthodontist in Germany Berlin –Free Word Template Download with AI
Prepared by a certified Orthodontist in Germany Berlin
Dr. med. dent. Katharina Hoffmann – Orthodontist PracticePrenzlauer Allee 142, 10405 Berlin, Germany
Phone: +49 (0)30 4455 6677 | Email: [email protected]
License No.: BZL-ORT-2019-0847 | Tax ID: DE 123 456 789
Member of the Berlin Association of Orthodontists (BVO)
1. Patient Information
| Field | Details |
|---|---|
| Patient Name | Maximilian Berger |
| Date of Birth | 22 March 2008 |
| Address | Wilmersdorfer Str. 88, 10707 Berlin, Germany |
| Health Insurance | AOK Berlin – Policy No. AOK-7782-3341 |
| Referring Physician | Dr. med. Stefan Krüger, General Dentist, Charlottenburg |
2. Clinical Assessment & Diagnosis
Following a comprehensive initial consultation conducted at our Orthodontist practice in Germany Berlin on 28 May 2025, a full diagnostic workup was performed. This included panoramic radiography (OPG), cephalometric analysis, intraoral impressions, digital 3D scanning, and a clinical examination of the occlusion, periodontal status, and soft-tissue profile. The Orthodontist, Dr. Hoffmann, identified the following conditions requiring intervention:
- Class II molar relationship with a 4 mm overjet
- Moderate crowding in the upper and lower anterior segments (approximately 6 mm)
- Deep overbite of 3 mm
- Mild midline deviation of the lower dental arch
- Normal periodontal health with no active caries detected
Based on these findings, the recommended treatment plan involves fixed orthodontic appliance therapy (braces) on both the upper and lower arches, followed by a retention phase. The estimated total treatment duration is 24 to 30 months.
3. Quotation Estimate – Itemised Cost Breakdown
The following Quotation Estimate reflects the full scope of orthodontic services to be provided by this Orthodontist practice in Germany Berlin. All prices are stated in Euro (EUR) and include applicable German value-added tax (MwSt.) at the current rate of 19%.
| Item No. | Description of Service | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 1 | Initial consultation, diagnostic imaging (OPG, cephalogram), digital 3D scan, and treatment planning | 1 | 280.00 | 280.00 |
| 2 | Pre-treatment periodontal scaling and polishing (both arches) | 1 | 195.00 | 195.00 |
| 3 | Placement of fixed orthodontic brackets and archwires – upper arch (14 brackets, 2 bands, 2 buccal tubes) | 1 | 1,450.00 | 1,450.00 |
| 4 | Placement of fixed orthodontic brackets and archwires – lower arch (14 brackets, 2 bands, 2 buccal tubes) | 1 | 1,450.00 | 1,450.00 |
| 5 | Monthly adjustment appointments (archwire changes, ligature replacement, elastics) – estimated 26 sessions | 26 | 85.00 | 2,210.00 |
| 6 | Interproximal reduction (IPR) – up to 12 surfaces | 1 | 320.00 | 320.00 |
| 7 | Removal of fixed appliances and debonding (both arches) | 1 | 480.00 | 480.00 |
| 8 | Post-treatment retention – fixed lingual retainers (upper and lower) plus two sets of removable Essix retainers | 1 | 650.00 | 650.00 |
| 9 | Post-treatment review appointments (3-month, 6-month, 12-month, 24-month) – 4 sessions | 4 | 60.00 | 240.00 |
| 10 | Emergency / urgent appointment allowance (up to 2 unplanned visits during active treatment) | 2 | 75.00 | 150.00 |
| Subtotal (incl. 19% MwSt.) | 7,425.00 | |||
| Statutory insurance reimbursement (AOK Berlin – KFO allowance) | − 1,200.00 | |||
| Patient's Estimated Out-of-Pocket Cost | 6,225.00 | |||
4. Payment Options
This Orthodontist practice in Germany Berlin offers flexible payment arrangements to ensure that the Quotation Estimate remains accessible to all patients. The following options are available:
- Lump-sum payment: Full amount payable upon commencement of treatment. A 3% discount (approximately 186.75 EUR) is applied for full upfront payment.
- Monthly instalment plan: The total patient cost may be divided into equal monthly payments over the duration of active treatment (approximately 26 months), resulting in a monthly payment of roughly 239.42 EUR. No additional interest is charged.
- Third-party financing: Partnerships with local Berlin banks (e.g., Berliner Sparkasse, Commerzbank) allow patients to arrange low-interest consumer loans specifically for orthodontic treatment.
5. Terms and Conditions of This Quotation Estimate
- This Quotation Estimate is valid for a period of 90 calendar days from the date of issue. After this period, prices may be subject to revision in accordance with the current Berlin dental fee schedule (Gebührenordnung für Zahnärzte – GOZ).
- The final cost may vary by up to ±10% depending on the actual clinical course of treatment, the number of adjustment sessions required, or any unforeseen complications identified by the Orthodontist during therapy.
- The patient is responsible for maintaining excellent oral hygiene throughout treatment. Failure to do so may result in additional periodontal or restorative procedures not included in this estimate.
- Should the patient discontinue treatment before completion, a pro-rata charge for remaining scheduled appointments will be applied as per the German Civil Code (BGB) provisions on contract termination.
- All data processing complies with the European General Data Protection Regulation (GDPR) and the German Federal Data Protection Act (BDSG). Patient records are stored securely in accordance with Berlin medical confidentiality regulations.
- This Quotation Estimate does not constitute a binding contract. A formal treatment agreement (Behandlungsvertrag) will be signed prior to the commencement of active orthodontic therapy.
- The Orthodontist practice in Germany Berlin reserves the right to refer the patient to a specialist (e.g., oral surgeon, periodontist) if additional interventions become necessary. Such referral costs are not included in this estimate.
6. Acceptance and Signature
By signing below, the patient acknowledges receipt of this Quotation Estimate and confirms understanding of the proposed orthodontic treatment plan, the associated costs, and the terms outlined above. This signature does not obligate the patient to commence treatment but serves as confirmation that the estimate has been reviewed.
Patient / Legal GuardianMaximilian Berger / Frau Ingrid Berger
Date: ______________________ Orthodontist – Dr. med. dent. K. Hoffmann
For: Hoffmann Orthodontie Berlin
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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