Quotation Estimate Orthodontist in Japan Osaka –Free Word Template Download with AI
Document No. QTE-OSK-2025-0487
Provider (Orthodontist)
Osaka Central Orthodontic Clinic
2-14-8 Umeda, Kita-ku
Osaka 530-0001, Japan
Tel: +81-6-6371-8820
Email: [email protected]
License No. ORTH-JP-2019-4471
Client / Patient
Mr. / Ms. [Patient Name]
Address: [Street, City, Prefecture]
Osaka, Japan
Tel: +81-90-XXXX-XXXX
Email: [[email protected]]
Insurance ID: [If Applicable]
Quotation Date: June 15, 2025 | Valid Until: July 15, 2025 | Currency: Japanese Yen (JPY) | Prepared By: Dr. Kenji Tanaka, DDS, OrthodontistThis Quotation Estimate has been prepared by our licensed Orthodontist team at Osaka Central Orthodontic Clinic, located in the heart of Japan Osaka. The following itemized breakdown reflects the comprehensive orthodontic treatment plan recommended after a full clinical examination, digital imaging, and diagnostic consultation conducted on June 10, 2025. All pricing is inclusive of applicable consumption tax (10%) as mandated by the National Tax Agency of Japan.
| No. | Service / Procedure | Frequency | Duration | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Records (X-rays, CBCT, Intraoral Scans) | One-time | 90 min | ¥25,000 | ¥25,000 |
| 2 | Custom Orthodontic Treatment Plan Design (3D Digital Simulation) | One-time | 60 min | ¥18,000 | ¥18,000 |
| 3 | Fixed Orthodontic Braces Placement (Ceramic / Metal) | One-time | 120 min | ¥150,000 | ¥150,000 |
| 4 | Monthly Orthodontist Adjustment & Wire Changes | 24 months | 45 min | ¥12,000 | ¥288,000 |
| 5 | Interproximal Reduction (IPR) & Bonding Repairs | As needed | 30 min | ¥8,000 | ¥24,000 |
| 6 | Removable Retainer Fabrication (Upper & Lower) | One-time | 60 min | ¥35,000 | ¥35,000 |
| 7 | Post-Treatment Follow-Up & Retainer Adjustments | 12 months | 30 min | ¥5,000 | ¥60,000 |
| 8 | Emergency Orthodontist Visit (Broken Bracket / Wire) | Up to 2 visits | 30 min | ¥10,000 | ¥20,000 |
| GRAND TOTAL (Incl. 10% Consumption Tax) | ¥620,000 | ||||
- Deposit: A non-refundable deposit of 20% (¥124,000) is required at the time of accepting this Quotation Estimate to secure your treatment slot with our Orthodontist in Japan Osaka.
- Installment Plan: The remaining balance may be paid in 24 equal monthly installments of ¥16,667, aligned with your monthly adjustment appointments. No additional interest is charged for on-time payments.
- Accepted Payment Methods: Cash, bank transfer (Japanese domestic), credit card (Visa, Mastercard, JCB), and Konbini convenience store payment.
- Insurance Note: Orthodontic treatment for cosmetic purposes is generally not covered by Japan's National Health Insurance. However, if the Orthodontist determines that the treatment is medically necessary (e.g., severe malocclusion affecting mastication), partial coverage may apply. Our front desk will assist with insurance verification.
- Quotation Validity: This Quotation Estimate is valid for 30 days from the date of issue. Prices are subject to revision based on material cost fluctuations or changes in Japanese tax regulations.
Dr. Kenji Tanaka, DDS, is a board-certified Orthodontist registered with the Japanese Orthodontic Society (JOS) and the Japanese Society of Orthodontists (JSO). He holds a Doctor of Dental Surgery degree from Osaka University Graduate School of Dentistry and completed a 3-year orthodontic residency program. Osaka Central Orthodontic Clinic is a licensed medical facility (Medical Institution License No. 29-B-01234) operating in compliance with all regulations set by the Osaka Prefectural Government. The clinic is equipped with state-of-the-art digital orthodontic technology, including iTero 5D scanners, CBCT imaging, and 3D-printed aligner fabrication, ensuring the highest standard of care for every patient in Japan Osaka.
By signing below, the patient (or legal guardian) acknowledges receipt of this Quotation Estimate, agrees to the scope of Orthodontist services outlined above, and authorizes the commencement of treatment at Osaka Central Orthodontic Clinic, Japan Osaka.
Patient / Guardian SignatureDate: _______________ Dr. Kenji Tanaka, DDS
Orthodontist — Osaka Central Orthodontic Clinic
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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