Quotation Estimate Orthodontist in Kuwait Kuwait City –Free Word Template Download with AI

Quotation Estimate No.: QE-2025-07834 Date of Issue: 14 June 2025 Valid Until: 14 July 2025 Patient / Client Information

Recipient Details

Patient Name: Mr. Ahmed Al-Rashidi

Civil ID No.: 2890115-2890-001

Address: Salmiya, Block 1, Street 3, House 45, Kuwait City, Kuwait

Phone: +965 9988 7766

Referring Physician: Dr. Fatima Al-Sabah (General Dentist, Kuwait City)

Insurance Provider: Bupa Kuwait (Policy No. BUP-KW-4452190)

Orthodontist & Practice Details

Attending Orthodontist

Lead Orthodontist: Dr. Khalid Al-Mutawa, BDS, MSc (Orthodontics), FRCPS (Edin)

Specialization: Comprehensive Orthodontic Treatment, Clear Aligners, Surgical Orthodontics

Years of Experience: 18 years in Kuwait, Kuwait City

Professional Registration: Kuwait Medical Specialization Board (KMSB) – Orthodontics

Clinic Hours: Sunday to Thursday, 9:00 AM – 9:00 PM | Friday, 4:00 PM – 9:00 PM

Scope of Orthodontic Treatment – Quotation Estimate Breakdown

This Quotation Estimate has been prepared by our Orthodontist team at Al-Nahda Orthodontic Center, located in the heart of Kuwait, Kuwait City, following a comprehensive clinical examination, digital panoramic radiograph (OPG), intraoral 3D scanning, and cephalometric analysis performed on 10 June 2025. The treatment plan below addresses Class II malocclusion with upper arch crowding and a 4 mm overjet. All pricing is quoted in Kuwaiti Dinars (KWD) and includes applicable VAT where mandated by Kuwaiti tax regulations.

No.	Orthodontic Procedure / Service	Frequency / Duration	Unit Price (KWD)	Total (KWD)	Notes
1	Initial Consultation & Diagnostic Records (OPG, CBCT, 3D Intraoral Scan, Photos, Study Models)	One-time	45.000	45.000	Included in plan
2	Pre-Orthodontic Periodontal Scaling & Polishing (Full Arch)	One-time	35.000	35.000	Required before appliance placement
3	Extraction of 4 Premolars (Upper 2, Lower 2) – Surgical	One-time	55.000 each	220.000	Performed by oral surgeon
4	Fixed Orthodontic Braces – Ceramic (Upper & Lower Arch)	18–24 months	1,250.000	1,250.000	Incl. brackets, wires, bands, elastics
5	Monthly Orthodontic Adjustment & Wire Changes	20 visits	25.000 each	500.000	Every 4–6 weeks
6	Interproximal Reduction (IPR) – Selective Enamel Reduction	As needed	15.000	15.000	Up to 0.5 mm per contact
7	Post-Orthodontic Retention – Fixed Lingual Retainers (Upper & Lower)	One-time	120.000	120.000	Composite-bonded wire
8	Removable Essix Retainers (2 sets – Upper & Lower)	One-time	80.000	80.000	Worn at night
9	Post-Treatment Follow-Up Visits (6 months, 12 months, 24 months)	3 visits	20.000 each	60.000	Retention monitoring
10	Emergency / De-bonding Visit (if bracket or wire breaks)	Up to 2 visits	15.000 each	30.000	Contingency allowance
Subtotal (KWD)				2,355.000
Insurance Coverage (Bupa Kuwait – 70%)				(1,648.500)
Patient Responsibility – Net Amount Due (KWD)				706.500

Payment Terms & Conditions

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Orthodontist reserves the right to revise pricing based on material cost fluctuations or updated clinical findings.
A non-refundable deposit of 25% (KWD 176.625) of the patient-responsibility amount is required to confirm the treatment plan and secure the appointment schedule at our Kuwait, Kuwait City clinic.
The remaining balance shall be payable in equal monthly installments over the duration of active orthodontic treatment, or in full upon completion of treatment, at the patient's preference.
All payments are to be made via bank transfer, credit/debit card, or cash at the Al-Nahda Orthodontic Center reception in Kuwait City, Kuwait. Official receipts will be issued in accordance with Kuwaiti commercial law.
Insurance pre-authorization must be obtained by the patient prior to the commencement of treatment. The clinic will assist in submitting claims to Bupa Kuwait but is not responsible for insurance policy limitations or exclusions.
Any additional procedures not listed in this Quotation Estimate (e.g., unexpected root canal therapy, additional extractions, or extended treatment beyond 24 months) will be quoted separately in writing before execution.
The patient acknowledges that orthodontic treatment outcomes, while predictable, may vary. The attending Orthodontist will communicate any mid-treatment plan modifications in a follow-up consultation.
This Quotation Estimate does not constitute a binding contract until both parties have signed and the deposit has been received. It serves as a good-faith estimate of costs for the described orthodontic care in Kuwait, Kuwait City.

Acceptance & Authorization

By signing below, the patient confirms that they have received, read, and understood this Quotation Estimate for orthodontic treatment. The patient agrees to the scope of work, estimated costs, and payment terms outlined above. The attending Orthodontist confirms that the treatment plan is clinically appropriate and that all diagnostic records have been reviewed.

Patient Signature
Name: Mr. Ahmed Al-Rashidi
Date: _______________ Orthodontist / Authorized Representative
Name: Dr. Khalid Al-Mutawa
Al-Nahda Orthodontic Center, Kuwait City
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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