Quotation Estimate Orthodontist in Germany Munich –Free Word Template Download with AI

Dear Patient,

Thank you for choosing our Orthodontist practice in Germany Munich for your orthodontic care. This Quotation Estimate has been prepared following your comprehensive initial consultation and diagnostic imaging (panoramic X-ray, cephalometric analysis, and intraoral digital impressions) conducted on 10 June 2025. The purpose of this Quotation Estimate is to provide you with a transparent, itemised breakdown of all anticipated orthodontic treatment costs, insurance contributions, and patient co-payments in accordance with the German statutory health insurance framework (GKV) and the applicable fee schedule (GOZ / KZR).

Based on the clinical examination performed by our Orthodontist in Germany Munich, the following diagnosis has been established: Class II malocclusion with upper incisor protrusion, moderate crowding in the lower arch, and a crossbite on the right posterior segment. The recommended treatment plan involves fixed orthodontic appliance therapy (braces) combined with interproximal reduction (IPR) and, if necessary, a subsequent retention phase. The estimated total treatment duration is 24 to 30 months.

This Quotation Estimate reflects the standard reimbursement rates under the German statutory health insurance (Gesetzliche Krankenversicherung – GKV) as defined by the KZR (Kostenverzeichnis für Zahnärztliche Leistungen). For patients with private health insurance (PKV), the applicable GOZ fee schedule will be applied, and a separate Quotation Estimate will be issued upon request. Our Orthodontist practice in Germany Munich accepts all major GKV and PKV providers. Payment of the patient co-payment portion may be arranged in monthly instalments over the treatment duration; please contact our practice administration in Munich to discuss available payment plans.

1. This Quotation Estimate is valid for a period of 90 calendar days from the date of issue (15 June 2025 to 15 September 2025). After this period, a revised Quotation Estimate may be required due to potential changes in material costs or insurance regulations in Germany Munich.
2. The total treatment cost is an estimate based on the current clinical findings. The Orthodontist in Germany Munich reserves the right to adjust the treatment plan and, consequently, the Quotation Estimate, should additional procedures become necessary during the course of therapy.
3. All prices are inclusive of the applicable German value-added tax (Mehrwertsteuer, currently 19%).
4. The patient is responsible for maintaining oral hygiene and attending all scheduled adjustment appointments. Missed appointments may result in additional fees as per the practice's cancellation policy.
5. This Quotation Estimate does not constitute a binding treatment contract. A separate informed consent form and treatment agreement will be signed prior to the initiation of orthodontic therapy.
6. In the event of early termination of treatment, a pro-rata adjustment to the Quotation Estimate will be calculated and communicated in writing.
7. All data processing in connection with this Quotation Estimate complies with the EU General Data Protection Regulation (GDPR / DSGVO) and the German Federal Data Protection Act (BDSG).

By signing below, the patient acknowledges receipt of this Quotation Estimate from the Orthodontist practice in Germany Munich and confirms understanding of the estimated costs, insurance coverage, and terms outlined above. This signature does not obligate the patient to commence treatment but serves as confirmation that the Quotation Estimate has been reviewed and understood.