Quotation Estimate Orthodontist in Ivory Coast Abidjan –Free Word Template Download with AI
Professional Orthodontist Services — Ivory Coast Abidjan
Provider
Clinique Dentaire Abidjan Excellence
12 Boulevard de la Paix, Cocody
Abidjan, Ivory Coast
Tel: +225 27 22 45 67 89
Email: [email protected]
RCCM: CI-ABJ-2019-B-04521
Client
Mr. Kouassi Adjoua
45 Rue des Jardins, Yopougon
Abidjan, Ivory Coast
Tel: +225 07 08 12 34 56
Email: [email protected]
Patient Ref: CD-2025-0847
This Quotation Estimate has been prepared by our team of certified Orthodontist specialists at Clinique Dentaire Abidjan Excellence, located in the heart of Ivory Coast Abidjan. Following a comprehensive clinical examination and digital radiographic assessment conducted on 10 June 2025, we are pleased to present the detailed cost breakdown for the full orthodontic treatment plan recommended for the patient. All services described herein are performed in accordance with the standards set by the Ivorian Ministry of Health and the National Order of Dentists of Ivory Coast.
| Ref | Description of Orthodontist Service | Qty | Unit Price (XOF) | Subtotal (XOF) |
|---|---|---|---|---|
| 01 | Initial comprehensive orthodontic consultation, intraoral photography, and digital panoramic radiograph (OPG) at our Abidjan clinic | 1 | 45,000 | 45,000 |
| 02 | Dental impressions and 3D intraoral scanning for custom orthodontic appliance fabrication | 1 | 60,000 | 60,000 |
| 03 | Full upper and lower fixed metal bracket system (orthodontic braces) — supply and placement by the Orthodontist | 1 | 850,000 | 850,000 |
| 04 | Monthly orthodontic adjustment and wire change sessions (estimated 18-month treatment duration) | 18 | 35,000 | 630,000 |
| 05 | Interproximal reduction (IPR) and minor tooth contouring as required during active treatment | 1 | 120,000 | 120,000 |
| 06 | Removable acrylic retainer (upper and lower) — fabrication and fitting post-debonding | 2 | 85,000 | 170,000 |
| 07 | Post-treatment follow-up consultations (3 sessions over 12 months) to monitor retention in Ivory Coast Abidjan | 3 | 25,000 | 75,000 |
| 08 | Emergency orthodontic visit (broken bracket, wire irritation) — included up to 2 visits | 2 | 30,000 | 60,000 |
| Subtotal | 2,010,000 XOF |
| VAT (18% — Ivorian tax code) | 361,800 XOF |
| Grand Total | 2,371,800 XOF |
This Quotation Estimate for orthodontic treatment is payable as follows: a deposit of 30% (711,540 XOF) is due upon acceptance to reserve the patient's slot with our Orthodontist team in Ivory Coast Abidjan. The remaining balance shall be settled in three equal monthly installments over the first three months of active treatment. Payment may be made by bank transfer to our account at Ecobank CI, mobile money (Orange Money, MTN MoMo, or Wave), or by cheque. All prices are inclusive of materials and clinical labor but exclude any unforeseen surgical extractions that may be recommended during treatment.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, pricing may be revised to reflect changes in material costs or exchange rates applicable in Ivory Coast Abidjan.
- The total treatment duration is estimated at eighteen (18) months; however, the Orthodontist reserves the right to extend or shorten this period based on the patient's biological response to treatment.
- The patient agrees to attend all scheduled adjustment appointments. Missed appointments beyond two (2) consecutive sessions may result in a re-scheduling fee of 20,000 XOF per occurrence.
- All orthodontic appliances are warranted against manufacturing defects for the duration of active treatment. Damage caused by patient negligence (e.g., biting hard objects) will incur additional repair charges at the Orthodontist's standard rate.
- Confidentiality of all clinical records, radiographs, and personal data is guaranteed in compliance with the Ivorian Data Protection Law (Loi n° 2013-450) and the professional ethics code of the National Order of Dentists of Ivory Coast.
- This Quotation Estimate does not constitute a binding contract until signed and countersigned by both parties. The patient's acceptance is confirmed by the payment of the initial deposit.
- Any additional procedures not listed in this document (e.g., orthognathic surgery, periodontal therapy) will be subject to a separate Quotation Estimate issued by the treating Orthodontist.
For Clinique Dentaire Abidjan Excellence
Dr. Awa N'Guessan
Lead Orthodontist & Director
For the Patient / Client
Mr. Kouassi Adjoua
Patient / Authorized Representative
Create your own Word template with our GoGPT AI prompt:
GoGPT