Quotation Estimate Orthodontist in Italy Naples –Free Word Template Download with AI
Dr. Maria Concetta Ferrante, Specialist Orthodontist
Via Toledo 187, 80132 Naples (NA), Italy
Practice Details:Studio Ortodontico Ferrante
Via Toledo 187, 80132 Naples (NA), Italy
P.IVA: 04587210634
Tel: +39 081 415 2233
Email: [email protected]
PEC: [email protected] Quotation Reference:
Ref. No.: QTE-2025-04871
Date of Issue: 14 June 2025
Valid Until: 14 September 2025
Currency: Euro (EUR) Patient Information
| Patient Name: Giuseppe Antonio De Luca | Date of Birth: 22 March 2003 |
| Address: Via Chiaia 94, 80121 Naples (NA), Italy | Phone: +39 333 456 7890 |
| SSN Code: DLCAQN03C22H509U | Referring Physician: Dr. L. Esposito (General Dentist, Naples) |
Following a comprehensive clinical examination, digital panoramic radiograph (OPG), intraoral photography, and cone-beam computed tomography (CBCT) performed at our Naples orthodontic clinic on 10 June 2025, the following diagnosis has been established: Class II malocclusion with upper incisor protrusion, moderate crowding in the lower arch, and a midline deviation of approximately 2 mm. The Orthodontist, Dr. Ferrante, has recommended a full fixed orthodontic appliance treatment combined with interproximal reduction (IPR) and a subsequent retention phase. This Quotation Estimate outlines all anticipated costs for the complete orthodontic treatment plan to be delivered at our practice in Naples, Italy.
Itemised Quotation Estimate – Orthodontic Services| No. | Description of Service | Frequency / Duration | Unit Price (EUR) | Total (EUR) | Notes |
|---|---|---|---|---|---|
| 1 | Initial consultation, clinical examination, and diagnostic records (OPG, CBCT, intraoral scans, photographs) | One-time | €320.00 | €320.00 | Performed in Naples |
| 2 | Placement of fixed orthodontic brackets (ceramic, upper and lower arches – 28 brackets total) with bonding and archwire insertion | One-time | €2,400.00 | €2,400.00 | Includes all brackets, wires, and bonding materials |
| 3 | Monthly orthodontic adjustment appointments (wire changes, elastic replacements, progress monitoring) | 18 months | €120.00 | €2,160.00 | Approx. 45 min per visit |
| 4 | Interproximal reduction (IPR) – selective enamel stripping for space creation in lower arch | 2 sessions | €180.00 | €360.00 | Performed by the Orthodontist |
| 5 | Removal of fixed appliances, debonding, and polishing of enamel surfaces | One-time | €450.00 | €450.00 | Includes final occlusal check |
| 6 | Retention phase – fabrication and fitting of fixed lingual retainers (upper and lower) plus two sets of removable Essix retainers | One-time + 12-month follow-up | €680.00 | €680.00 | Includes 3 check-up visits in Naples |
| 7 | Emergency orthodontic appointments (broken bracket, wire irritation, appliance repair) – estimated allowance | Up to 3 visits | €90.00 | €270.00 | Charged only if required |
| 8 | Final panoramic radiograph and post-treatment documentation | One-time | €110.00 | €110.00 | For medical records |
| Subtotal (before VAT): | €6,750.00 | ||||
| VAT (IVA) 22% – Healthcare exemption applies (Art. 10 DPR 633/72): | €0.00 | Exempt | |||
| GRAND TOTAL – QUOTATION ESTIMATE: | €6,750.00 | ||||
- Payment Schedule: The total amount of €6,750.00 may be settled in full upon placement of the orthodontic appliance, or in 18 equal monthly instalments of €375.00, aligned with the adjustment appointment schedule in Naples.
- Accepted Payment Methods: Bank transfer (IBAN: IT60 X054 2811 1000 0000 4567 890), credit/debit card (Visa, Mastercard, American Express), or cash (up to €4,999.99 per Italian anti-money-laundering regulations).
- Deposit: A non-refundable deposit of €500.00 is required to reserve the treatment start date and secure the appointment slot with the Orthodontist in Naples.
- SSN / Health Insurance: This Quotation Estimate reflects private (out-of-pocket) pricing. If the patient holds a valid SSN entitlement or private health insurance covering orthodontic treatment in Italy, the applicable reimbursement will be deducted, and a revised Quotation Estimate will be issued.
- Cancellation Policy: Cancellation of a scheduled appointment in Naples must be communicated at least 48 hours in advance. No-shows or late cancellations will be charged at 50% of the scheduled visit fee.
- Validity: This Quotation Estimate is valid for 90 days from the date of issue. After this period, a new clinical assessment may be required, and pricing may be subject to revision.
- Compliance: All orthodontic procedures are performed in full compliance with Italian healthcare regulations (D.Lgs. 219/2017 – Patient's Rights) and the professional code of conduct of the Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Napoli.
By signing below, the patient acknowledges receipt of this Quotation Estimate for orthodontic treatment in Naples, Italy, and confirms understanding of the scope, estimated duration, and financial terms outlined above. The patient's signature does not constitute an obligation to proceed but indicates informed awareness of the proposed treatment plan by the Orthodontist.
Patient / Legal Guardian:_________________________________
Name: Giuseppe Antonio De Luca
Date: _______________ Orthodontist / Practice Representative:
_________________________________
Dr. Maria Concetta Ferrante
Specialist Orthodontist, Naples, Italy
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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