Quotation Estimate Orthodontist in Iraq Baghdad –Free Word Template Download with AI
Orthodontist Professional Services
Baghdad, Republic of Iraq
Official Quotation Estimate DocumentProvider Details
Dr. Ahmed Al-Rashid, DDS, MSc
Lead Orthodontist & Clinic Director
Al-Mansour Orthodontic Center
Al-Mansour District, Baghdad, Iraq
Tel: +964 770 123 4567
Email: [email protected]
License No. IQ-ORT-2019-0452
Client / Patient Details
Patient Name: [To be completed]
Age / Gender: [To be completed]
Address: Baghdad, Iraq
Phone: [To be completed]
National ID No.: [To be completed]
Referral Source: [To be completed]
Quotation Reference
Quotation Estimate No.: QTE-2025-BGH-0847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days)
Currency: Iraqi Dinar (IQD) / USD
Scope of Service
Specialty: Orthodontist Treatment
Location: Iraq Baghdad – Al-Mansour District
Estimated Duration: 18–24 months
Number of Sessions: 24–32 visits
This Quotation Estimate is prepared by the undersigned Orthodontist to provide a comprehensive, transparent, and itemized cost breakdown for the full orthodontic treatment plan to be delivered at our clinic in Iraq Baghdad. The services outlined below represent the complete scope of care the patient will receive from initial consultation through final retention. All procedures are performed in accordance with the standards set by the Iraqi Ministry of Health and the International Association for Orthodontists (IAO).
| Item No. | Service / Procedure | Frequency | Unit Cost (IQD) | Unit Cost (USD) | Total (IQD) | Total (USD) |
|---|---|---|---|---|---|---|
| 01 | Initial Orthodontist Consultation & Diagnostic Records (X-rays, panoramic radiograph, intraoral photographs, digital impressions) | 1x | 75,000 | $57 | 75,000 | $57 |
| 02 | Comprehensive Treatment Planning & Digital Simulation (3D treatment preview) | 1x | 100,000 | $76 | 100,000 | $76 |
| 03 | Placement of Fixed Metal Braces (full upper and lower arches, including bonding of brackets and archwires) | 1x | 1,200,000 | $912 | 1,200,000 | $912 |
| 04 | Monthly Orthodontist Adjustment Visits (wire changes, elastic adjustments, progress monitoring) | 22x | 50,000 | $38 | 1,100,000 | $836 |
| 05 | Interproximal Reduction (IPR) / Enamel Stripping (if clinically required) | 1x | 150,000 | $114 | 150,000 | $114 |
| 06 | Extraction of Premolars (up to 4 teeth, including local anesthesia and post-extraction care) | 1x | 400,000 | $304 | 400,000 | $304 |
| 07 | Removal of Braces & Final Archwire Placement | 1x | 200,000 | $152 | 200,000 | $152 |
| 08 | Custom-Fabricated Retainers (upper and lower, including 6-month follow-up checks) | 1x | 350,000 | $266 | 350,000 | $266 |
| 09 | Emergency / Unscheduled Orthodontist Visits (broken bracket, wire irritation – up to 3 visits) | 3x | 35,000 | $27 | 105,000 | $81 |
| 10 | Final Post-Treatment Records & Orthodontist Report (for patient records and future reference) | 1x | 50,000 | $38 | 50,000 | $38 |
| GRAND TOTAL (All Services) | 3,930,000 | $2,996 | ||||
This Quotation Estimate for Orthodontist services in Iraq Baghdad may be settled through the following payment schedule. The patient is required to pay a minimum of 30% as a deposit at the time of accepting this Quotation Estimate to secure the treatment start date.
- Deposit (30%): 1,179,000 IQD / $899 – due upon signing
- Second Installment (40%): 1,572,000 IQD / $1,198 – due at the 6-month mark
- Final Installment (30%): 1,179,000 IQD / $899 – due at brace removal
Payments may be made in Iraqi Dinar (IQD) or US Dollars (USD) at the prevailing Central Bank of Iraq exchange rate on the date of payment. Bank transfer to the clinic's registered account in Baghdad is accepted. Cash payments are also available at the front desk.
3.1. This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Orthodontist reserves the right to revise pricing due to changes in material costs, import tariffs, or currency fluctuations in Iraq Baghdad.
3.2. The total treatment duration of 18 to 24 months is an estimate. The Orthodontist may adjust the number of adjustment visits based on the patient's biological response and progress. Any additional visits beyond the 22 scheduled adjustments will be billed at the standard rate of 50,000 IQD per visit.
3.3. The patient is responsible for maintaining oral hygiene and attending all scheduled Orthodontist appointments. Missed appointments exceeding three (3) without prior notice may result in a rescheduling fee of 25,000 IQD per occurrence.
3.4. In the event of appliance damage caused by the patient (e.g., biting hard objects, sports-related trauma), repair costs will be charged separately and are not included in this Quotation Estimate.
3.5. All diagnostic records, digital files, and treatment plans remain the intellectual property of the Orthodontist and the clinic. The patient receives a copy of the final report for personal records.
3.6. This Quotation Estimate does not include general dental treatments such as fillings, root canal therapy, or periodontal surgery. Any such procedures identified during the course of orthodontic treatment will be quoted separately.
3.7. The clinic operates in compliance with all regulations of the Iraqi Ministry of Health. The Orthodontist holds a valid practicing license in the Republic of Iraq and is a member of the Iraqi Orthodontic Society.
3.8. In the unlikely event of a medical emergency arising during treatment, the Orthodontist will provide immediate care at the clinic in Iraq Baghdad. Emergency hospital transfer fees, if required, are the patient's responsibility.
By signing below, the patient (or legal guardian) acknowledges that they have read and understood this Quotation Estimate for Orthodontist services in Iraq Baghdad. The patient agrees to the payment schedule, terms, and conditions outlined in this document. The Orthodontist confirms that the treatment plan described herein is based on a thorough clinical examination and diagnostic records obtained on the date of the initial consultation.
Patient / Legal Guardian
Name: _________________________Signature: _________________________
Date: _________________________
Orthodontist / Clinic Representative
Name: Dr. Ahmed Al-Rashid, DDSSignature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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