Quotation Estimate Orthodontist in New Zealand Wellington –Free Word Template Download with AI
142 Lambton Quay, Te Aro, Wellington 6011, New Zealand
Phone: +64 4 472 8830 | Email: [email protected]
Provider Number: 456-789-012 | NZQA Registered Orthodontist
Quotation EstimatePrepared For
Client Name: Ms. Sarah Mitchell
Address: 27 Khandallah Avenue, Khandallah, Wellington 6024, New Zealand
Phone: 021 456 7890
Email: [email protected]
Quotation Details
Quotation No.: WO-2025-04871
Date Issued: 14 June 2025
Valid Until: 14 September 2025 (90 days)
Prepared By: Dr. James Henderson, Orthodontist
New Zealand Wellington
Dear Ms. Mitchell,
Thank you for visiting the Wellington Orthodontic Centre for your initial consultation on 28 May 2025. Following a comprehensive clinical examination, digital panoramic radiograph, intraoral photography, and detailed discussion of your orthodontic needs, we are pleased to present this Quotation Estimate for your orthodontic treatment plan. This document outlines the full scope of services, associated costs, and payment options available to you as a patient of our Orthodontist practice here in New Zealand Wellington.
| Item No. | Description of Service | Frequency | Unit Price (NZD) | Estimated Total (NZD) |
|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Records (X-rays, photos, digital scan) | One-time | $450.00 | $450.00 |
| 2 | Custom-Made Ceramic Braces – Upper & Lower Arch (appliance fabrication and bonding) | One-time | $3,200.00 | $3,200.00 |
| 3 | Orthodontic Adjustment Appointments (wire changes, elastic adjustments, progress monitoring) | Every 6–8 weeks (approx. 14 visits) | $185.00 | $2,590.00 |
| 4 | Interproximal Reduction (IPR) – selective enamel reshaping for space creation | As required (est. 3 sessions) | $120.00 | $360.00 |
| 5 | Removable Retainers (Hawley type) – Upper & Lower | One-time | $480.00 | $480.00 |
| 6 | Post-Treatment Retention Review (6-month and 12-month check-ups) | 2 visits | $150.00 | $300.00 |
| 7 | Emergency / Breakage Repairs (estimated allowance for 2 incidents) | As needed | $95.00 | $190.00 |
| Estimated Grand Total (NZD, inclusive of GST) | $7,570.00 | |||
This Quotation Estimate from our Orthodontist in New Zealand Wellington offers the following flexible payment structures to suit your financial circumstances:
- Option A – Full Payment: Pay the full amount of $7,570.00 at the commencement of treatment. A 5% early-payment discount of $378.50 applies, reducing your total to $7,191.50.
- Option B – Staged Payments: An initial deposit of $1,500.00 at the bonding appointment, followed by 12 equal monthly instalments of $480.83. No interest is charged on this plan.
- Option C – Finance via Provider: We partner with local New Zealand finance providers offering 0% interest over 18 or 24 months. A small administrative fee of $99.00 applies. Contact our front desk for application details.
- This Quotation Estimate is valid for 90 days from the date of issue. Prices are subject to review in accordance with the New Zealand Orthodontic Association's recommended 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 is 18 to 24 months. Actual duration may vary depending on individual biological response and compliance with appliance-wearing instructions.
- Should additional procedures become necessary during treatment (e.g., extraction of premolars, placement of orthodontic mini-screws/anchors), a supplementary Quotation Estimate will be provided and must be approved in writing before any additional work commences.
- Missed appointments must be rescheduled at least 48 hours in advance. A late-cancellation or no-show fee of $120.00 will apply to unrescheduled visits.
- This Quotation Estimate does not constitute a guarantee of a specific aesthetic outcome. The Orthodontist will use reasonable clinical judgement throughout treatment to achieve the best possible result within the parameters of your individual anatomy.
- Our practice is located in the heart of Te Aro, Wellington, and is fully accessible via public transport (Wellington Railway Station is a 5-minute walk). Parking is available at the adjacent Lambton Quay car park.
- All patient records, digital scans, and radiographs are stored in compliance with the New Zealand Privacy Act 2020 and the Health Information Privacy Code 1994.
- By accepting this Quotation Estimate, you consent to the treatment plan outlined above and agree to the terms stated herein. A signed copy of this document will be retained in your clinical file at our Wellington Orthodontic Centre.
I, the undersigned, have received and reviewed this Quotation Estimate for orthodontic treatment. I understand the scope of services, the estimated costs, and the payment options presented. I accept this Quotation Estimate and authorise the Wellington Orthodontic Centre to proceed with the treatment plan as described.
Client Signature: ___________________________
Print Name: Sarah Mitchell
Date: _______________
Orthodontist Signature: ___________________________
Print Name: Dr. James Henderson, Orthodontist
Date: _______________
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