Quotation Estimate Orthodontist in Ghana Accra –Free Word Template Download with AI
Professional Orthodontist Services — Ghana Accra
Accra Smile Orthodontics & Dental Centre12 Independence Avenue, Osu
Accra, Ghana
Tel: +233 30 274 5561
Email: [email protected] Quotation Reference: QTE-ORT-2025-0487
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Currency: Ghana Cedis (GHS)
| Prepared For: | Mr. Kwame Asante — 45 Ring Road, East Legon, Accra, Ghana |
| Contact Number: | +233 24 555 8892 |
| Referring Physician: | Dr. Ama Serwaa — Korle-Bu Teaching Hospital, Accra |
| Scope of Work: | Comprehensive Orthodontist Treatment Plan — Fixed Appliance Therapy (Metal Braces) with Retention Phase |
This Quotation Estimate has been prepared by our licensed Orthodontist, Dr. Nana Yaw Boateng (GMDA Member No. 4521), to outline the full scope of orthodontic treatment required for the patient. The treatment plan addresses moderate crowding of the anterior teeth, a Class II molar relationship, and a mild crossbite on the left posterior segment. All services are delivered at our clinic in Ghana Accra, in full compliance with the standards set by the Ghana Dental Association and the Ministry of Health, Republic of Ghana.
| Item | Description of Orthodontist Service | Qty | Unit Price (GHS) | Total (GHS) |
|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Records (Panoramic X-ray, Cephalometric X-ray, Intraoral Photographs, Digital Impressions, Clinical Examination by Orthodontist) | 1 | 1,850.00 | 1,850.00 |
| 2 | Pre-Orthodontic Dental Treatment (Scaling, Polishing, Restoration of two carious molars, Periodontal Assessment) | 1 | 3,200.00 | 3,200.00 |
| 3 | Extraction of Four Premolars (Upper 4, Upper 5, Lower 4, Lower 5) under Local Anaesthesia | 4 | 650.00 | 2,600.00 |
| 4 | Placement of Fixed Metal Braces (Full Arch — Upper and Lower) including brackets, archwires, bands, and bonding materials | 1 | 12,500.00 | 12,500.00 |
| 5 | Monthly Orthodontist Adjustment Visits (Archwire changes, Elastics, Power Chain Adjustments, Progress Monitoring) — 18-month treatment duration | 18 | 450.00 | 8,100.00 |
| 6 | Removal of Fixed Appliances & Final Records (Post-treatment X-rays, Photographs, Digital Scan) | 1 | 1,200.00 | 1,200.00 |
| 7 | Retention Phase — Fabrication and Fitting of Upper and Lower Fixed Retainers (Bonded behind anterior teeth) plus two sets of Removable Acrylic Retainers | 1 | 2,800.00 | 2,800.00 |
| 8 | Six-Monthly Retention Review Visits (First 2 Years Post-Treatment) — 4 visits total | 4 | 350.00 | 1,400.00 |
| 9 | Emergency Orthodontist Appointments (Bracket re-bonding, Wire trimming, Elastic replacement) — Up to 3 visits included | 3 | 300.00 | 900.00 |
| 10 | Comprehensive Treatment Plan Documentation & Digital Records Storage (Lifetime access to patient file at our Ghana Accra clinic) | 1 | 500.00 | 500.00 |
| SUBTOTAL | 35,050.00 | |||
| VAT (15% — Ghana Revenue Authority) | 5,257.50 | |||
| GRAND TOTAL | 40,307.50 | |||
This Quotation Estimate for Orthodontist services in Ghana Accra may be settled under the following payment schedule:
- Deposit (30%): GHS 12,092.25 — Due upon acceptance of this Quotation Estimate, prior to the initial consultation.
- Second Instalment (40%): GHS 16,123.00 — Due at the placement of fixed metal braces (approximately Month 2).
- Final Instalment (30%): GHS 12,092.25 — Due at the removal of appliances and fitting of retainers (approximately Month 19).
Payment may be made via bank transfer to our account at Ecobank Ghana (Account: 1102-4567-8901, Branch: Osu, Accra), mobile money (MTN MoMo / Telecel Cash), or by cheque. All payments are subject to the prevailing exchange rates and Ghana Revenue Authority tax regulations.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, prices may be revised to reflect changes in material costs, exchange rates, or regulatory fees applicable in Ghana Accra.
- The Orthodontist treatment duration of eighteen (18) months is an estimate. Actual treatment time may vary by two to four months depending on individual biological response, patient compliance with elastic wear, and attendance at all scheduled adjustment visits.
- The patient is required to attend all monthly Orthodontist adjustment appointments. Missed appointments beyond two consecutive visits may result in a re-scheduling fee of GHS 200.00 per occurrence.
- Any additional procedures not listed in this Quotation Estimate (e.g., orthognathic surgery referral, additional extractions, or extended retention) will be quoted separately in writing before commencement.
- Our clinic in Ghana Accra operates Monday to Friday, 8:00 AM to 5:00 PM, and Saturday, 9:00 AM to 1:00 PM. Emergency Orthodontist appointments are available by phone during business hours.
- All clinical records, radiographs, and digital scans remain the property of Accra Smile Orthodontics & Dental Centre. The patient retains the right to request copies at a nominal reproduction cost.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. The Orthodontist will use best clinical judgement in accordance with the standards of the Ghana Dental Association.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the Republic of Ghana, with jurisdiction vested in the courts of Accra.
By signing below, the patient acknowledges receipt of this Quotation Estimate, agrees to the scope of Orthodontist treatment described herein, and accepts the terms and conditions outlined in Section 4. The patient further confirms that the Orthodontist has explained the proposed treatment plan, alternative options, potential risks, and expected outcomes in understandable terms.
For: Accra Smile Orthodontics & Dental CentreDr. Nana Yaw Boateng — Lead Orthodontist
GMDA Member No. 4521
Date: ____________________ Patient / Guardian Acceptance
Name: Kwame Asante
Signature: ____________________
Date: ____________________ ⬇️ Download as DOCX Edit online as DOCX
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