Quotation Estimate Orthodontist in New Zealand Auckland –Free Word Template Download with AI
Orthodontist Treatment Plan & Fee Schedule
Auckland Orthodontic Centre
142 Victoria Street West, Ponsonby, Auckland 1011, New Zealand
Phone: +64 9 374 5520 | Email: [email protected]
NZBN: 9429045678901 | HPC Reg. No: 123456
This Quotation Estimate has been prepared by our registered Orthodontist, Dr. James Tane, at the Auckland Orthodontic Centre, to provide Ms. Sarah Mitchell with a comprehensive and transparent breakdown of all anticipated costs associated with her proposed orthodontic treatment. As a specialist practice located in the heart of New Zealand Auckland, we are committed to delivering world-class orthodontic care while ensuring full financial clarity for every patient. This document serves as a formal Quotation Estimate and does not constitute a binding contract until accepted in writing by the patient.
Following a thorough clinical examination, digital radiographic imaging (panoramic and cephalometric X-rays), intraoral scanning, and a detailed consultation conducted on 5 June 2025, our Orthodontist has recommended a comprehensive fixed-appliance orthodontic treatment plan. The details of the recommended treatment, associated fees, and payment options are outlined below.
Based on the clinical findings, the Orthodontist recommends the following treatment protocol to correct Class II malocclusion, anterior crowding, and mild midline deviation. The estimated total treatment duration is 24 to 30 months, with regular adjustment appointments scheduled every six to eight weeks throughout the course of treatment in our New Zealand Auckland clinic.
| Item No. | Description of Service | Frequency | Unit Price (NZD) | Estimated Total (NZD) |
|---|---|---|---|---|
| 1 | Initial Consultation, Clinical Examination & Diagnostic Records (X-rays, intraoral scan, photographs) | One-off | $450.00 | $450.00 |
| 2 | Orthodontic Treatment Plan & Written Report by Specialist Orthodontist | One-off | $250.00 | $250.00 |
| 3 | Fixed Metal Braces – Upper & Lower Arch (banding, bonding, wire insertion) | One-off | $4,800.00 | $4,800.00 |
| 4 | Monthly Adjustment & Progression Appointments (wire changes, elastic adjustments, ligature changes) | 28 visits | $185.00 | $5,180.00 |
| 5 | Interproximal Reduction (IPR) – selective enamel stripping for crowding relief | As required | $120.00 | $480.00 |
| 6 | Orthodontic Elastics & Auxiliary Appliances (supplied per visit) | 28 visits | $25.00 | $700.00 |
| 7 | Debonding & Removal of Fixed Appliances (upper and lower arches) | One-off | $650.00 | $650.00 |
| 8 | Fixed Retainers (upper & lower) – bonded behind front teeth | One-off | $800.00 | $800.00 |
| 9 | Removable Retainers (Hawley type) – upper & lower, including one replacement set | One-off | $550.00 | $550.00 |
| 10 | Emergency / Unscheduled Appointments (broken bracket, wire irritation, etc.) | Up to 4 visits | $150.00 | $600.00 |
| 11 | Post-Treatment Review & Retainer Check (12-month and 24-month follow-ups) | 2 visits | $120.00 | $240.00 |
| TOTAL ESTIMATED COST (NZD, incl. GST) | $14,700.00 | |||
To make this Quotation Estimate accessible, our Orthodontist practice in New Zealand Auckland offers the following payment structures:
- Full Payment at Commencement: A 10% discount applies, reducing the total to $13,230.00 NZD.
- Deposit & Instalment Plan: A non-refundable deposit of $2,000.00 at the time of accepting this Quotation Estimate, followed by 24 equal monthly instalments of $529.17 NZD (interest-free).
- Third-Party Financing: We partner with MedFinance NZ and Afterpay to offer flexible financing over 12, 24, or 36 months. Interest rates and terms are determined by the financier and are not the responsibility of the Orthodontist or the practice.
- This Quotation Estimate is valid for a period of 90 days from the date of issue. Fees are subject to review and may be adjusted in accordance with the New Zealand Health Practitioners Competence Assurance Council (HPCAA) fee guidelines and the practice's annual fee schedule.
- All prices are quoted in New Zealand Dollars (NZD) and include Goods and Services Tax (GST) at the current rate of 15%.
- The estimated treatment duration of 24–30 months is a professional estimate provided by the Orthodontist. Actual treatment time may vary depending on patient compliance, biological response, and any unforeseen clinical developments.
- Patients are responsible for the cost of any additional procedures not included in this Quotation Estimate, such as extractions, periodontal treatment, or restorative dentistry, which may be recommended by the Orthodontist during the course of treatment.
- Missed appointments must be rescheduled at least 48 hours in advance. A late-cancellation fee of $100.00 NZD applies to appointments cancelled with less than 48 hours' notice or no-shows.
- This Quotation Estimate does not cover the cost of orthodontic treatment for any additional family members. Separate Quotation Estimates will be issued for each patient.
- By signing below, the patient acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions outlined herein. This does not obligate the patient to commence treatment but reserves the quoted fees for the validity period stated.
- All clinical care is provided in accordance with the Code of Health and Disability Services Consumers' Rights (New Zealand) and the HPCAA Code of Professional Conduct for Orthodontists.
By signing below, I confirm that I have received and reviewed this Quotation Estimate from the Orthodontist at Auckland Orthodontic Centre, New Zealand Auckland. I understand the recommended treatment plan, the associated costs, and the payment options available. I accept the terms and conditions set out in this document.
Patient Signature: Ms. Sarah MitchellDate: ______________________ Orthodontist / Practice Representative: Dr. James Tane, BDS, MOrth (NZ)
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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