Quotation Estimate Orthodontist in Myanmar Yangon –Free Word Template Download with AI
Orthodontist Professional Services — Myanmar Yangon
Ref: QTE-ORT-2025-0472 | Date: 15 June 2025 | Valid Until: 15 July 2025
Issued By (Orthodontist Practice)
Golden Smile Orthodontic Centre
No. 42, 27th Street, Kamayut Township
Yangon, Myanmar 11111
Tel: +95 9 791 234 567
Email: [email protected]
License No: MM-ORT-2019-00847
Prepared For (Patient / Client)
Mr. Aung Kyaw Min
No. 18, Bogyoke Avenue
Kyauktada Township
Yangon, Myanmar 11111
Tel: +95 9 456 789 012
ID No: 14000123456
This Quotation Estimate is issued by Golden Smile Orthodontic Centre, a licensed and registered Orthodontist practice operating in Myanmar Yangon, to provide Mr. Aung Kyaw Min with a comprehensive, itemised breakdown of the anticipated costs for full orthodontic treatment. This document serves as a formal financial projection and is not a binding contract. All prices are quoted in Myanmar Kyat (MMK) and are subject to the terms and conditions outlined in Section 6 of this Quotation Estimate. The Orthodontist team at our Myanmar Yangon clinic has conducted a preliminary clinical assessment and digital imaging review to prepare this estimate based on the patient's current dental and skeletal condition.
2. Clinical Summary & Recommended Treatment PlanFollowing a comprehensive examination performed by Dr. Thiri Aung, Lead Orthodontist, at our Myanmar Yangon facility on 10 June 2025, the following diagnosis has been established: Class II malocclusion with moderate crowding in the maxillary arch, a 4 mm overjet, and mild mandibular rotation. The recommended treatment protocol involves fixed orthodontic appliances (metal brackets) on both arches with an estimated treatment duration of 24 to 30 months. The Orthodontist team has also recommended periodic panoramic radiographs and intraoral scans at intervals of six months to monitor progress and make necessary adjustments to the treatment plan.
3. Itemised Quotation Estimate Breakdown| No. | Service / Item Description | Quantity | Unit Price (MMK) | Total (MMK) |
|---|---|---|---|---|
| 1 | Initial Consultation & Comprehensive Orthodontic Examination (including digital panoramic X-ray, intraoral photographs, and cephalometric analysis) | 1 session | 150,000 | 150,000 |
| 2 | Customised Treatment Plan Design & Digital Smile Simulation (performed by the Orthodontist specialist team) | 1 package | 200,000 | 200,000 |
| 3 | Fixed Metal Orthodontic Brackets & Archwires (32 brackets, 4 archwires, elastic ligatures, and molar bands) — full set for both arches | 1 set | 2,800,000 | 2,800,000 |
| 4 | Bracket Bonding & Initial Archwire Placement (bilateral maxillary and mandibular arches) | 1 procedure | 1,200,000 | 1,200,000 |
| 5 | Monthly Adjustment & Follow-up Visits (wire changes, elastic replacements, progress monitoring by the Orthodontist) | 28 visits | 120,000 | 3,360,000 |
| 6 | Interim Panoramic Radiographs & Intraoral Digital Scans (every 6 months for treatment monitoring) | 5 scans | 95,000 | 475,000 |
| 7 | Debonding, Finishing, & Polishing (removal of all brackets, archwires, and residual adhesive; final occlusal adjustment) | 1 procedure | 800,000 | 800,000 |
| 8 | Fixed Palatal Retainer (maxillary arch) & Removable Mandibular Retainer (Hawley type, acrylic with wire) | 1 set | 650,000 | 650,000 |
| 9 | Post-Treatment Retention Check-ups (quarterly visits for the first 12 months, then biannually for 24 months) | 12 visits | 80,000 | 960,000 |
| 10 | Emergency Orthodontic Repair (broken bracket, displaced wire, or elastic replacement) — estimated allowance | 2 repairs | 150,000 | 300,000 |
| GRAND TOTAL (Quotation Estimate) | 10,895,000 MMK | |||
To facilitate the treatment process, the Orthodontist practice in Myanmar Yangon offers the following payment structure. The patient may choose to pay the full amount upfront or opt for the instalment plan detailed below. All payments are to be made at the clinic reception in Myanmar Yangon or via bank transfer to the account specified on the receipt.
| Instalment | Due Date | Amount (MMK) | Notes |
|---|---|---|---|
| 1st (Deposit) | Upon acceptance of this Quotation Estimate | 2,000,000 | Covers initial consultation, treatment plan, and bracket ordering |
| 2nd | Month 3 of treatment | 2,500,000 | Covers bonding and first 3 adjustment visits |
| 3rd | Month 9 of treatment | 2,500,000 | Covers ongoing adjustments and interim scans |
| 4th | Month 18 of treatment | 2,500,000 | Covers mid-treatment phase |
| 5th (Final) | Month 24 of treatment | 1,395,000 | Covers debonding, retainers, and retention check-ups |
This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue (15 June 2025). After this period, the Orthodontist practice reserves the right to revise pricing due to changes in material costs, exchange rate fluctuations affecting imported orthodontic components, or updated clinical recommendations. Acceptance of this Quotation Estimate constitutes the patient's agreement to the treatment plan, payment schedule, and all terms outlined herein. The patient is requested to sign and return a copy of this document to the Myanmar Yangon clinic within the validity period to confirm acceptance and schedule the initial bonding appointment.
6. Terms & Conditions- This Quotation Estimate is a good-faith projection of costs and does not constitute a fixed-price guarantee. The Orthodontist may adjust the scope of treatment based on clinical progress, and any material changes will be communicated in writing.
- The patient agrees to attend all scheduled adjustment appointments at the Myanmar Yangon clinic. Missed appointments exceeding two consecutive visits may result in a rescheduling fee of 50,000 MMK per occurrence.
- The Orthodontist practice is not liable for damage to appliances caused by the patient's failure to follow dietary and hygiene instructions provided at each visit.
- All personal health data and radiographic images are handled in strict accordance with Myanmar's data protection regulations and the clinic's confidentiality policy.
- In the event of treatment interruption exceeding three months, a re-evaluation fee of 100,000 MMK will apply before resuming active treatment.
- This Quotation Estimate is non-transferable and is issued exclusively to the named patient. Any change of patient requires a new clinical assessment and a revised Quotation Estimate from the Orthodontist.
- Disputes arising from this Quotation Estimate shall be resolved through amicable negotiation. If unresolved, matters shall be referred to the Myanmar Dental Association's dispute resolution panel in Yangon.
For Golden Smile Orthodontic Centre
(Orthodontist Practice, Myanmar Yangon)
Lead Orthodontist & Practice Director
Signature & Date: ________________________
Patient / Guardian Acknowledgement
Mr. Aung Kyaw MinSignature & Date: ________________________ ⬇️ Download as DOCX Edit online as DOCX
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