Quotation Estimate Orthodontist in Mexico Mexico City –Free Word Template Download with AI
Professional Orthodontist Services — Mexico, Mexico City
Document No. QTE-2025-0847 1. Client InformationRecipient
Name: [Patient / Guardian Full Name]
Address: [Street, Colony, Postal Code], Mexico City, Mexico
Phone: +52 (55) XXXX-XXXX
Email: [[email protected]]
Practice Details
Clinic Name: Clínica Ortodóntica del Centro
Address: Av. Paseo de la Reforma 245, Col. Juárez, C.P. 06600, Mexico City, Mexico
Phone: +52 (55) 5512-3456
Email: [email protected]
2. Scope of Orthodontist ServicesThis Quotation Estimate is issued by our licensed Orthodontist practice located in Mexico, Mexico City, and outlines the comprehensive orthodontic treatment plan recommended following the initial clinical evaluation. The services described below encompass the full course of orthodontic care, including diagnostic imaging, appliance fabrication, active treatment, retention, and all necessary follow-up consultations. All procedures will be performed in accordance with the standards established by the Mexican Ministry of Health (Secretaría de Salud) and the professional guidelines of the Mexican Association of Orthodontists (Asociación Mexicana de Ortodoncia).
3. Itemized Cost Breakdown| No. | Service / Procedure | Frequency | Unit Cost (MXN) | Total (MXN) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Clinical Examination | One-time | $1,200.00 | $1,200.00 |
| 2 | Full Panoramic X-Ray (OPG) & Cephalometric Radiograph | One-time | $1,800.00 | $1,800.00 |
| 3 | Intraoral Digital Impressions & 3D Model Scanning | One-time | $2,500.00 | $2,500.00 |
| 4 | Orthodontic Treatment Plan & Digital Simulation (ClinCheck) | One-time | $3,000.00 | $3,000.00 |
| 5 | Placement of Fixed Metal Braces (Full Arch, Upper & Lower) | One-time | $18,000.00 | $18,000.00 |
| 6 | Monthly Orthodontist Adjustment & Wire Changes | 22 months | $1,500.00 | $33,000.00 |
| 7 | Elastic Bands, O-Rings & Auxiliary Appliances (Monthly Supply) | 22 months | $350.00 | $7,700.00 |
| 8 | Removal of Braces & Polishing (Both Arches) | One-time | $2,000.00 | $2,000.00 |
| 9 | Fabrication & Placement of Fixed Retainers (Upper & Lower) | One-time | $4,500.00 | $4,500.00 |
| 10 | Removable Night Retainers (Vivaplast, Upper & Lower) | One-time | $3,200.00 | $3,200.00 |
| 11 | Post-Treatment Retention Check-ups (6 months, 12 months, 18 months, 24 months) | 4 visits | $800.00 | $3,200.00 |
| 12 | Emergency Appointments (Brace Breakage, Soft-Tissue Irritation) | Up to 3 visits | $600.00 | $1,800.00 |
| SUBTOTAL (Before IVA) | $85,900.00 | |||
| IVA (16% Tax) | $13,744.00 | |||
| GRAND TOTAL | $99,644.00 | |||
This Quotation Estimate from our Orthodontist clinic in Mexico, Mexico City may be settled through the following payment options:
| Option | Structure | Applicable Fee |
|---|---|---|
| A – Full Prepayment | 100% at the time of treatment initiation | 5% discount applied (Total: $94,661.80 MXN) |
| B – Installment Plan | 22 monthly payments aligned with adjustment visits | No additional fee (Total: $99,644.00 MXN) |
| C – Credit Card / Bank Transfer | 3-month or 6-month installment via authorized financial institution | Interest as determined by the issuing bank |
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, prices may be subject to revision based on material costs and prevailing economic conditions in Mexico City, Mexico.
- All orthodontic procedures will be carried out exclusively by the attending Orthodontist, Dr. Alejandro Ramírez Soto, or by a qualified associate under direct supervision, in compliance with the regulations of the Mexican Health Ministry.
- The estimated treatment duration of twenty-two (22) months is a clinical projection. Actual duration may vary depending on the patient's biological response, compliance with instructions, and any unforeseen clinical developments. No additional charges will apply for adjustments within a reasonable extension of up to six (6) months.
- The patient is responsible for maintaining proper oral hygiene and attending all scheduled appointments at our clinic in Mexico, Mexico City. Missed appointments exceeding two (2) consecutive visits may result in a re-evaluation fee of $500.00 MXN per occurrence.
- In the event of appliance damage caused by the patient (e.g., biting hard objects, sports-related trauma), a repair fee of $800.00 MXN per incident will apply, in addition to the emergency visit fee already included in this estimate.
- All prices are quoted in Mexican Pesos (MXN) and include applicable IVA (Impuesto al Valor Agregado) at the current rate of 16%. No additional government taxes or surcharges apply.
- This Quotation Estimate does not constitute a binding contract until a signed treatment agreement is executed by both parties at our Mexico City, Mexico office.
- Confidentiality of all patient records, radiographic images, and digital treatment plans is guaranteed in accordance with the Mexican Federal Law on Protection of Personal Data Held by Private Parties (LFPDPPP).
- Warranty: The Orthodontist practice guarantees the integrity of all fabricated appliances for a period of twelve (12) months from the date of placement, covering defects in materials or workmanship under normal use conditions.
- Any disputes arising from this Quotation Estimate or the subsequent treatment will be resolved under the civil and commercial laws of the State of Mexico City, Mexico, and the competent courts of that jurisdiction.
By signing below, the patient or legal guardian acknowledges receipt of this Quotation Estimate for Orthodontist services in Mexico, Mexico City, agrees to the terms and conditions outlined herein, and authorizes the commencement of the described orthodontic treatment plan.
Patient / Legal GuardianName: ______________________________
Signature: ______________________________
Date: ______________________________ Orthodontist – Dr. Alejandro Ramírez Soto
Name: Alejandro Ramírez Soto
Signature: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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