Quotation Estimate Orthodontist in Italy Milan –Free Word Template Download with AI
Orthodontic Treatment Plan & Financial Estimate
Issued by a Licensed Orthodontist Practice in Italy Milan
Orthodontist Practice
Studio Ortodontico Dott.ssa Elena Marchetti
Via Montenapoleone, 42
20121 Milan (MI), Italy
Tel: +39 02 8645 7721
Email: [email protected]
P.IVA: IT02847561096
Albo Odontoiatri di Milano – Iscr. n. 14872
Client Information
Patient: Marco Rossi
Date of Birth: 14/03/1998
Address: Via Torino, 18, 20123 Milan (MI), Italy
Phone: +39 335 678 9012
Email: [email protected]
Referral Code: OM-2025-0347
| Quotation Estimate No.: | QE-2025-0892 | Date of Issue: | 12 June 2025 |
| Valid Until: | 12 September 2025 (90 days) | Currency: | Euro (EUR) – Italy |
| Treatment Duration: | Estimated 24 months | Consultation Date: | 28 May 2025 |
This Quotation Estimate has been prepared by the undersigned Orthodontist, Dott.ssa Elena Marchetti, operating in Italy Milan, following a comprehensive clinical examination, digital radiographic imaging (panoramic and cephalometric X-rays), intraoral scanning, and a detailed diagnostic analysis conducted on 28 May 2025. The purpose of this document is to provide the patient with a transparent, itemised financial breakdown of the proposed orthodontic treatment plan, including all professional fees, laboratory costs, materials, and scheduled follow-up appointments. This Quotation Estimate does not constitute a binding contract but serves as a good-faith financial projection based on current pricing standards in the Milan metropolitan area.
Based on the diagnostic findings, the Orthodontist recommends a full-arch fixed orthodontic treatment using self-ligating ceramic brackets (upper and lower arches) combined with a period of retention. The treatment aims to correct a Class II molar relationship, moderate crowding in the lower anterior segment, and a mild midline deviation. The estimated total treatment duration is twenty-four (24) months, including an active phase of approximately twenty (20) months and a retention phase of four (4) months.
| Ref. | Description of Service / Item | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 01 | Initial orthodontic consultation, clinical examination, and diagnostic assessment by the Orthodontist in Milan | 1 session | € 180.00 | € 180.00 |
| 02 | Full diagnostic imaging: panoramic radiograph (OPG), lateral cephalometric X-ray, and digital intraoral scan (upper and lower arches) | 1 set | € 220.00 | € 220.00 |
| 03 | Orthodontic treatment planning, model analysis, and digital simulation (ClinCheck / 3D treatment preview) | 1 set | € 150.00 | € 150.00 |
| 04 | Placement of self-ligating ceramic brackets – upper arch (14 brackets + archwire + ligatures) | 1 arch | € 1,450.00 | € 1,450.00 |
| 05 | Placement of self-ligating ceramic brackets – lower arch (14 brackets + archwire + ligatures) | 1 arch | € 1,450.00 | € 1,450.00 |
| 06 | Monthly orthodontic adjustment appointments (archwire changes, elastic adjustments, progress monitoring) – 20 sessions | 20 sessions | € 95.00 | € 1,900.00 |
| 07 | Interproximal reduction (IPR) / enameloplasty for lower anterior crowding (estimated 8 surfaces) | 8 surfaces | € 35.00 | € 280.00 |
| 08 | Removal of fixed appliances, final impressions, and fabrication of upper and lower fixed retainers (0.016" stainless steel wire bonded to palatal/lingual surfaces) | 1 set | € 480.00 | € 480.00 |
| 09 | Retention phase: 4 follow-up appointments for retainer check and adjustment (months 21–24) | 4 sessions | € 70.00 | € 280.00 |
| 10 | Emergency / unscheduled orthodontic visits (broken bracket, wire irritation) – estimated allowance | 2 visits | € 60.00 | € 120.00 |
| 11 | Post-treatment panoramic radiograph for final documentation and records | 1 X-ray | € 80.00 | € 80.00 |
| TOTAL ESTIMATED COST (before VAT) | € 6,590.00 | |||
| VAT (IVA) 22% – Applicable in Italy | € 1,449.80 | |||
| GRAND TOTAL (VAT included) | € 8,039.80 | |||
The total amount of this Quotation Estimate may be settled according to the following schedule, as agreed between the Orthodontist and the patient:
| Installment | Due Date | Amount (EUR, VAT incl.) |
|---|---|---|
| 1st – Upon acceptance of this Quotation Estimate | 15 June 2025 | € 2,000.00 |
| 2nd – At bracket placement (Month 1) | 15 July 2025 | € 2,000.00 |
| 3rd – Month 6 | 15 January 2026 | € 2,000.00 |
| 4th – Month 12 | 15 July 2026 | € 1,500.00 |
| 5th – Month 18 (debonding & retainers) | 15 January 2027 | € 539.80 |
Payment may be made by bank transfer (IBAN: IT60 X030 1234 5678 9012 3456 789), credit/debit card, or in cash at the practice in Milan. A 1.5% monthly late-payment interest will apply to overdue installments in accordance with Italian civil code provisions.
- This Quotation Estimate is a non-binding financial projection. The final treatment plan may be adjusted by the Orthodontist based on clinical progress observed during the active phase.
- The patient is required to attend all scheduled orthodontic appointments at the practice in Italy Milan. Cancellations must be made at least 48 hours in advance; otherwise, a no-show fee of € 50.00 will be charged.
- The patient must adhere to all dietary and hygiene instructions provided by the Orthodontist to ensure optimal treatment outcomes and to minimise the risk of appliance damage.
- In the event of treatment interruption exceeding three (3) consecutive months, a re-entry fee of € 200.00 will be applied, and the remaining balance may become immediately due.
- All personal data processed in connection with this Quotation Estimate and the subsequent treatment are handled in full compliance with the EU General Data Protection Regulation (GDPR – Regulation 2016/679) and applicable Italian privacy legislation (D.Lgs. 196/2003 as amended).
- This Quotation Estimate is governed by the laws of the Italian Republic. Any disputes shall be subject to the exclusive jurisdiction of the competent courts of Milan, Italy.
- The Orthodontist practice maintains professional liability insurance (RC professionale) with a coverage of € 2,000,000 per claim, as required by the Ordine degli Odontoiatri di Milano.
By signing below, the patient acknowledges having received and reviewed this Quotation Estimate, confirms understanding of the proposed orthodontic treatment plan, and agrees to the terms and conditions outlined herein. The Orthodontist confirms that all information provided is accurate to the best of their professional knowledge as of the date of issue.
For the Orthodontist Practice:
Dott.ssa Elena Marchetti – Orthodontist
Albo Odontoiatri di Milano, Iscr. n. 14872
Signature & DatePatient / Legal Guardian:
Marco Rossi
Resident in Milan, Italy
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