Quotation Estimate Orthodontist in Malaysia Kuala Lumpur –Free Word Template Download with AI
Provider Details
Dr. Aisha Rahman, DDS, MSc (Ortho)
KL Smile Orthodontic Centre
Suite 1204, Level 12, Menara KL
Jalan Sultan Ismail, 50250 Kuala Lumpur
Malaysia
Tel: +60 3-2181 4567
Email: [email protected]
Reg. No: MD-2019-08834
Client Details
Mr. Tan Wei Ming
Flat 18-07, The Troika Residence
316, Jalan Ampang, 50450 Kuala Lumpur
Malaysia
Tel: +60 12-345 6789
Email: [email protected]
IC No: 850612-10-4521
Quotation Estimate Details
Date Issued: 15 June 2025
Valid Until: 15 July 2025
Payment Currency: Malaysian Ringgit (MYR / RM)
Service Location: Kuala Lumpur, Malaysia
Diagnosis Summary
Condition: Class II Malocclusion with Crowding
Recommended Treatment: Fixed Orthodontic Braces (Metal)
Estimated Duration: 24–30 months
Consultation Date: 10 June 2025
This Quotation Estimate has been prepared by our experienced Orthodontist team at KL Smile Orthodontic Centre, located in the heart of Malaysia Kuala Lumpur. The following costs reflect the comprehensive orthodontic treatment plan recommended after a thorough clinical examination, digital X-ray imaging, and intraoral scanning conducted on 10 June 2025. All prices are quoted in Malaysian Ringgit (RM) and are inclusive of all standard clinical materials used during each appointment.
| No. | Description of Orthodontist Service | Frequency | Unit Cost (RM) | Total (RM) | Notes |
|---|---|---|---|---|---|
| 1 | Initial Consultation & Comprehensive Orthodontic Assessment (including panoramic X-ray, cephalometric analysis, and digital intraoral scan) | One-time | 350.00 | 350.00 | Waived upon treatment acceptance |
| 2 | Orthodontic Treatment Plan Formulation & Digital Simulation (3D treatment preview) | One-time | 200.00 | 200.00 | Included in package |
| 3 | Fixed Metal Braces — Bonding & Initial Archwire Placement (upper and lower arches) | One-time | 4,500.00 | 4,500.00 | Includes all brackets, bands, and wires |
| 4 | Monthly Orthodontist Adjustment & Wire Change Appointments | 28 months | 250.00 | 7,000.00 | Every 4–6 weeks as scheduled |
| 5 | Intermediate Orthodontic Appliances (elastics, rubber bands, power chain replacements) | 28 months | 80.00 | 2,240.00 | Consumables per visit |
| 6 | Debonding & Finishing (removal of all brackets, polishing, and final occlusal adjustment) | One-time | 800.00 | 800.00 | Includes final X-ray verification |
| 7 | Retainer Fabrication & Fitting (Hawley retainer — upper and lower) | One-time | 1,200.00 | 1,200.00 | Two sets included |
| 8 | Post-Treatment Orthodontist Follow-Up Reviews (retainer check-ups) | 6 visits (Year 1) | 100.00 | 600.00 | Every 2 months in first year |
| 9 | Emergency Orthodontist Visit (broken bracket, wire irritation — up to 2 visits) | As needed | 150.00 | 300.00 | Provisional allowance |
| 10 | Professional Dental Hygiene & Scaling (pre-treatment and mid-treatment) | 2 sessions | 280.00 | 560.00 | Recommended by Orthodontist |
| GRAND TOTAL — Quotation Estimate | RM 17,750.00 | MYR | |||
Important Conditions
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After the expiry date, the Orthodontist team reserves the right to revise pricing based on updated material costs and clinical reassessment.
- All services described in this Quotation Estimate will be performed by a registered Orthodontist or supervised orthodontic assistant at our clinic in Malaysia Kuala Lumpur, in full compliance with the Malaysian Dental Council (MDC) regulations and the Malaysian Orthodontic Society (MOS) clinical guidelines.
- The estimated treatment duration of 24–30 months is a clinical projection. Actual duration may vary depending on patient compliance, biological response, and any unforeseen orthodontic complications identified during the course of treatment.
- Should the patient require additional orthodontic procedures not covered in this Quotation Estimate (e.g., orthognathic surgery referral, additional extractions, or extended retention), a supplementary Quotation Estimate will be issued and must be approved in writing by the patient before any additional work commences.
- Missed appointments must be rescheduled at least 48 hours in advance. Cancellations made less than 24 hours before a scheduled Orthodontist visit will incur a no-show fee of RM 100.00.
- This Quotation Estimate does not include hospitalisation, general anaesthesia, or specialist referrals outside the scope of orthodontic care. Any such additional costs will be communicated separately.
- All personal health data and treatment records are handled in accordance with the Personal Data Protection Act 2010 (PDPA) of Malaysia. Patient confidentiality is maintained at all times within our Malaysia Kuala Lumpur facility.
- Warranty: The Orthodontist provides a 12-month warranty on all bonded appliances against manufacturing defects. Normal wear, patient-induced damage, or failure to attend scheduled reviews will void the warranty.
- Disputes arising from this Quotation Estimate shall be governed by the laws of Malaysia and subject to the exclusive jurisdiction of the courts in Kuala Lumpur, Malaysia.
By signing below, the patient acknowledges that this Quotation Estimate has been reviewed, all terms and conditions have been understood, and the recommended Orthodontist treatment plan is accepted. The patient agrees to the payment schedule and clinical protocols outlined in this document.
Patient / Guardian SignatureName: Tan Wei Ming
Date: _______________ Orthodontist / Authorised Representative
Name: Dr. Aisha Rahman, DDS
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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