Quotation Estimate Orthodontist in India Bangalore –Free Word Template Download with AI
Orthodontic Treatment Services
SmileCraft Orthodontics & Dental Care Centre
No. 42, 100 Feet Road, Indiranagar, Bangalore, Karnataka – 560038, India
Phone: +91-80-4123-5678 | Email: [email protected]
Valid for 30 Days
1. Patient & Clinical SummaryThis Quotation Estimate has been prepared by our senior Orthodontist, Dr. Meera Nair (MDS, Orthodontics & Dentofacial Orthopaedics, Gold Medalist – Bangalore University), following a comprehensive clinical examination conducted on 10 June 2025 at our clinic in Bangalore, India. The patient presents with Class II malocclusion, moderate crowding in the mandibular arch, and a 3 mm overjet. After thorough radiographic analysis (OPG and cephalometric tracing) and intraoral impressions, the Orthodontist has recommended a full-course fixed orthodontic treatment plan as detailed below.
2. Itemised Quotation Estimate – Treatment Breakdown| S.No. | Description of Service / Procedure | Unit | Rate (INR) | Amount (INR) | Remarks |
|---|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Workup (OPG, Cephalo, Intraoral Photos, Digital Scans) | 1 | ₹ 3,500 | ₹ 3,500 | One-time |
| 2 | Fixed Metal Braces – Upper Arch (14 brackets + bands + archwires) | 1 | ₹ 45,000 | ₹ 45,000 | DBA 0016 |
| 3 | Fixed Metal Braces – Lower Arch (14 brackets + bands + archwires) | 1 | ₹ 45,000 | ₹ 45,000 | DBA 0016 |
| 4 | Interproximal Reduction (IPR) – both arches (up to 20 surfaces) | 1 | ₹ 8,000 | ₹ 8,000 | As needed |
| 5 | Monthly Orthodontic Adjustments & Wire Changes (18 months estimated) | 18 | ₹ 2,500 | ₹ 45,000 | Every 4–6 weeks |
| 6 | Removable Retainers (Hawley type) – Upper & Lower | 2 | ₹ 4,500 | ₹ 9,000 | Post-debonding |
| 7 | Debonding, Finishing & Polishing (both arches) | 1 | ₹ 6,000 | ₹ 6,000 | Final visit |
| 8 | Post-Treatment Review & Retainer Adjustments (6 months) | 3 | ₹ 1,500 | ₹ 4,500 | At 1, 3 & 6 months |
| 9 | Emergency / Breakage Repairs (up to 3 incidents) | 3 | ₹ 1,000 | ₹ 3,000 | Bracket/wire re-cement |
| Subtotal | ₹ 169,000 | ||||
| GST @ 18% (as applicable in India) | ₹ 30,420 | ||||
| Grand Total (Quotation Estimate) | ₹ 199,420 | ||||
| Milestone | Amount (INR) | Due Date |
|---|---|---|
| Advance (on signing this Quotation Estimate) | ₹ 50,000 | 15 June 2025 |
| Second instalment (after 6 months of treatment) | ₹ 75,000 | Dec 2025 |
| Third instalment (after 12 months of treatment) | ₹ 50,000 | Jun 2026 |
| Final payment (at debonding) | ₹ 24,420 | Dec 2026 |
4.1 This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Beyond this period, the Orthodontist reserves the right to revise pricing based on material cost fluctuations in the Indian dental supply market.
4.2 The total treatment duration is estimated at 18 months; however, the Orthodontist in Bangalore, India, may extend or shorten the timeline based on the patient's biological response and compliance with oral hygiene instructions.
4.3 All fees quoted are inclusive of standard materials. Any additional procedures (e.g., extractions, surgical orthodontics, or temporary anchorage devices) will be communicated separately with a revised Quotation Estimate before commencement.
4.4 The patient agrees to attend all scheduled appointments. Missed appointments beyond two consecutive visits may result in a re-scheduling fee of ₹ 1,000 per instance.
4.5 In the event of early discontinuation of treatment, a non-refundable processing fee of 15% of the remaining balance shall be applicable, as per the standard practice of Orthodontist clinics in India Bangalore.
4.6 This Quotation Estimate does not constitute a guarantee of specific aesthetic outcomes. The Orthodontist will use best clinical judgement in line with the Indian Dental Association (IDA) ethical guidelines.
4.7 All personal health data will be handled in strict compliance with the Digital Personal Data Protection Act, 2023, applicable in India.
Note: This Quotation Estimate is prepared exclusively for the patient named above and is non-transferable. SmileCraft Orthodontics, Bangalore, India, is a registered dental practice (Karnataka State Dental Council Reg. No. KSDC/2019/4472). For any clarification regarding this estimate, please contact our front desk or the treating Orthodontist directly. For SmileCraft OrthodonticsDr. Meera Nair, MDS (Ortho)
Lead Orthodontist, Bangalore, India Patient / Guardian Signature
Mr. Arjun Ramesh Kumar
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