Quotation Estimate Orthodontist in Kenya Nairobi –Free Word Template Download with AI
Nairobi Orthodontic & Dental Care Centre
Waiyaki Way, Westlands, Kenya Nairobi
1. Client InformationPrepared For
Patient Name: Mr. James Mwangi Kariuki
Address: 14 Riverside Drive, Kilimani, Kenya Nairobi
Phone: +254 712 345 678
Email: [email protected]
National ID: 24567890
2. Provider InformationOrthodontist Practice Details
Practice Name: Nairobi Orthodontic & Dental Care Centre
Lead Orthodontist: Dr. Amina Wanjiru Otieno, BDS, MOrth (Kenya)
License No.: KMDA-ORTH-2019-00342
Address: Suite 4, Medical Plaza, Waiyaki Way, Westlands, Kenya Nairobi
Phone: +254 20 271 8900
Email: [email protected]
Physical Therapy & Dental Council Registration: Valid through 2026
3. Scope of Orthodontist ServicesThis Quotation Estimate outlines the comprehensive orthodontic treatment plan recommended by our senior Orthodontist in Kenya Nairobi following a full clinical examination, panoramic radiograph (OPG), intraoral digital impressions, and cephalometric analysis conducted on 10 June 2025. The treatment addresses Class II malocclusion with upper anterior crowding and a 4 mm overjet. The following services and procedures are included in this Quotation Estimate:
4. Itemised Quotation Estimate Breakdown| # | Service / Procedure | Duration | Unit Price (KES) | Total (KES) | Notes |
|---|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Workup (OPG, CBCT, digital scans, photos) | 1 session | 8,500 | 8,500 | One-time fee |
| 2 | Comprehensive Treatment Planning by Lead Orthodontist | 1 session | 5,000 | 5,000 | Included in plan |
| 3 | Fixed Metal Braces – Upper & Lower Arch (bracket bonding, wire placement) | 2 sessions | 45,000 | 90,000 | DBA 022 brackets |
| 4 | Monthly Orthodontist Adjustment Appointments (wire changes, elastics, progress checks) | 18 months | 3,500 | 63,000 | 18 visits total |
| 5 | Interproximal Reduction (IPR) – selective enamel stripping | 2 sessions | 4,000 | 8,000 | As clinically indicated |
| 6 | Removable Retainers (Hawley type) – Upper & Lower | 1 session | 12,000 | 12,000 | Post-treatment |
| 7 | Post-Treatment Follow-Up & Retainer Adjustments (12 months) | 4 visits | 2,500 | 10,000 | 3-monthly visits |
| 8 | Emergency Orthodontist Visits (broken bracket, wire irritation) – up to 3 visits | As needed | 2,000 | 6,000 | Within treatment period |
| 9 | Professional Dental Hygiene & Scaling (pre-treatment) | 1 session | 6,500 | 6,500 | Recommended |
| 10 | Final Radiograph & Post-Treatment Records | 1 session | 4,500 | 4,500 | Documentation |
| SUBTOTAL | 213,500 | ||||
| VAT (16% – Kenya Revenue Authority) | 34,160 | ||||
| GRAND TOTAL (KES) | 247,660 | ||||
This Quotation Estimate may be settled through the following payment arrangements, subject to mutual agreement between the patient and the Orthodontist practice in Kenya Nairobi:
- Option A – Full Payment: 100% of the Grand Total (KES 247,660) payable prior to the commencement of active orthodontic treatment. A 5% discount (KES 12,383) shall be applied for full upfront payment, reducing the total to KES 235,277.
- Option B – Instalment Plan: A 30% deposit (KES 74,298) due at the time of bracket bonding, with the remaining 70% (KES 173,362) spread over 17 monthly instalments of KES 10,198 each, payable on or before the 5th of each month via M-Pesa, bank transfer, or cheque.
- Option C – Insurance / NHIF: Where applicable, the patient may submit this Quotation Estimate to their medical insurance provider or the National Hospital Insurance Fund (NHIF) for partial or full reimbursement. The practice will provide an itemised receipt upon request.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Prices are subject to revision upon expiry due to changes in material costs or regulatory adjustments by the Kenya Medical Practitioners and Dentists Council.
- All prices are quoted in Kenyan Shillings (KES) and are inclusive of standard clinical materials. Any additional procedures not listed herein (e.g., orthognathic surgery referral, additional extractions) will be quoted separately in a supplementary Quotation Estimate.
- The Orthodontist in Kenya Nairobi reserves the right to modify the treatment plan if clinical progress deviates from the initial prognosis. Any such modifications will be communicated in writing and require the patient's informed consent before additional charges are incurred.
- Missed appointments must be rescheduled at least 48 hours in advance. No-shows or late cancellations will incur a fee of KES 1,500 per occurrence.
- The patient is responsible for maintaining oral hygiene throughout the orthodontic treatment period. Failure to do so may extend treatment duration and is not covered under this Quotation Estimate.
- Warranty: All orthodontic appliances are guaranteed against manufacturing defects for a period of six (6) months from the date of placement. Normal wear and tear, damage due to trauma, or patient negligence is excluded from warranty coverage.
- This Quotation Estimate does not constitute a binding contract until signed and countersigned by both parties. The practice operates in full compliance with the Kenya Data Protection Act (2019) regarding patient records and personal information.
- Disputes arising from this Quotation Estimate shall be resolved through the Kenya Medical Practitioners and Dentists Council (KMPDC) or, failing that, through the courts of competent jurisdiction in Kenya Nairobi.
By signing below, the patient acknowledges receipt of this Quotation Estimate for Orthodontist services in Kenya Nairobi, confirms understanding of the scope of treatment, payment terms, and conditions outlined above, and authorises the Nairobi Orthodontic & Dental Care Centre to proceed with the recommended orthodontic treatment plan.
Patient / Guardian SignatureName: _________________________
Date: _________________________
Orthodontist / Authorised RepresentativeName: Dr. Amina Wanjiru Otieno
Date: _________________________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT