Quotation Estimate Orthodontist in Germany Frankfurt –Free Word Template Download with AI
Orthodontic Treatment Plan & Cost Estimate
Orthodontist Practice – Dr. med. dent. Katharina Weber
Mainzer Landstraße 142
60329 Frankfurt am Main
Germany
Tel: +49 (0)69 4455 8821
Email: [email protected]
VAT ID: DE 298 445 102
Prepared For (Patient)
Name: [Patient Full Name]
Address: [Patient Address]
Frankfurt am Main, Germany
Date of Birth: [DD/MM/YYYY]
Insurance: [Insurance Provider]
Policy No.: [Policy Number]
This Quotation Estimate has been prepared by our Orthodontist practice located in Germany Frankfurt to provide you with a comprehensive, transparent, and itemised breakdown of the anticipated costs associated with your proposed orthodontic treatment. As a licensed Orthodontist operating in the city of Frankfurt, Germany, we are committed to ensuring that every patient receives a detailed financial overview before commencing any course of treatment. This document serves as a non-binding estimate and does not constitute a final invoice. All figures are based on the clinical assessment conducted during your initial consultation on 02 June 2025.
Following a thorough examination, including panoramic X-ray (OPG), cephalometric radiograph, intraoral photography, and digital impression, our Orthodontist in Germany Frankfurt has identified the following conditions requiring intervention: Class II malocclusion with a 6 mm overjet, moderate crowding in the upper arch (approximately 4 mm), and a slight crossbite in the posterior region. The recommended treatment plan involves fixed orthodontic appliances on both arches, followed by a retention phase.
| Item No. | Description of Service | Frequency | Unit Cost (EUR) | Total (EUR) |
|---|---|---|---|---|
| 01 | Initial consultation, clinical examination, and digital records (X-ray, photos, impressions) | One-time | 180.00 | 180.00 |
| 02 | Orthodontic treatment plan development and patient consultation | One-time | 120.00 | 120.00 |
| 03 | Placement of fixed orthodontic brackets (upper and lower arch, 28 brackets total) | One-time | 2,400.00 | 2,400.00 |
| 04 | Monthly adjustment and wire changes (estimated 20 visits) | Monthly | 95.00 | 1,900.00 |
| 05 | Interproximal reduction (IPR) – enamel stripping (estimated 12 surfaces) | As needed | 45.00 | 540.00 |
| 06 | Elastics and auxiliary appliances (supplies for full treatment) | Monthly | 25.00 | 500.00 |
| 07 | Debonding of all brackets and finishing (polishing, contouring) | One-time | 350.00 | 350.00 |
| 08 | Retention appliances (fixed lingual retainers upper & lower + removable retainers) | One-time | 680.00 | 680.00 |
| 09 | Retention check-ups (estimated 6 visits over 2 years) | Periodic | 60.00 | 360.00 |
| 10 | Emergency appointments (estimated 2 unplanned visits) | As needed | 75.00 | 150.00 |
| Subtotal (before statutory deduction) | 7,180.00 | |||
| Statutory health insurance contribution (GKV – approx. 50% of GOZ fee) | −3,590.00 | |||
| Patient's Estimated Out-of-Pocket Cost | 3,590.00 | |||
This Quotation Estimate from our Orthodontist practice in Germany Frankfurt offers the following payment options:
- Full payment: 5% discount applied to the patient's out-of-pocket cost, payable upon placement of appliances.
- Monthly instalments: The patient's share may be divided into equal monthly payments over the duration of active treatment (approximately 20 months). No interest is charged.
- Insurance pre-approval: We will submit the treatment plan to your statutory or private health insurance provider (Krankenkasse) for prior authorisation. The final reimbursement amount is determined solely by your insurer.
Please note: This Quotation Estimate is a good-faith projection based on current clinical findings. The final cost may vary depending on the complexity encountered during treatment, additional procedures that may become necessary, or changes in the patient's oral condition. Our Orthodontist in Germany Frankfurt reserves the right to adjust the treatment plan and corresponding costs with prior written consent from the patient. All prices are exclusive of applicable German value-added tax (MwSt.), which is included in the figures above as per GOZ regulations. This estimate is valid for 90 calendar days from the date of issue.
- This Quotation Estimate is non-binding and does not create a contractual obligation for either party until a separate treatment agreement is signed.
- The patient is responsible for maintaining oral hygiene and attending all scheduled appointments at our Orthodontist clinic in Frankfurt, Germany.
- Missed appointments without 48-hour prior notice may incur a fee of €50.00 per occurrence.
- In the event of appliance damage due to patient negligence (e.g., biting hard objects), repair costs will be billed separately.
- All personal data processed in connection with this estimate are handled in accordance with the German Federal Data Protection Act (BDSG) and the EU General Data Protection Regulation (GDPR).
- Disputes regarding this Quotation Estimate shall be governed by the laws of the Federal Republic of Germany, with jurisdiction at the local court of Frankfurt am Main.
By signing below, the patient acknowledges receipt of this Quotation Estimate and confirms that the proposed orthodontic treatment plan has been explained in detail by the treating Orthodontist in Germany Frankfurt. The patient's signature does not constitute acceptance of the estimate but confirms understanding of the information provided.
For the Orthodontist PracticeDr. med. dent. Katharina Weber
Frankfurt am Main, Germany
Date: _______________ Patient / Legal Guardian
Name: _______________
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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