Quotation Estimate Orthodontist in Nigeria Lagos –Free Word Template Download with AI
Lagos Smile Orthodontic Centre
14B Adeola Odeku Street, Victoria Island, Lagos, Nigeria
Tel: +234 (0) 803 555 7210 | Email: [email protected]
RCN No: RC/2019/04582 | NMC Registration: NMC/ORT/2021/0034
1. INTRODUCTION AND SCOPE OF SERVICESThis Quotation Estimate is issued by Lagos Smile Orthodontic Centre, a fully licensed and accredited Orthodontist practice operating in Nigeria Lagos, to provide a comprehensive and transparent breakdown of all anticipated orthodontic treatment costs for the patient named above. Our Orthodontist, Dr. Funke Adebayo (MDS, Ortho, FRCN), has over fourteen years of clinical experience in comprehensive orthodontic care, and this Quotation Estimate reflects the standard fee structure applied to all patients at our Nigeria Lagos clinic.
The scope of services outlined in this Quotation Estimate covers a full course of fixed orthodontic appliance therapy, including initial diagnostic work, active treatment phases, retention, and all necessary follow-up consultations. All pricing is denominated in Nigerian Naira (NGN) and is subject to the terms and conditions stated herein.
2. ITEMIZED QUOTATION ESTIMATE – TREATMENT BREAKDOWN| S/N | Description of Orthodontist Service | Qty | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|---|
| 1 | Initial Consultation & Comprehensive Orthodontic Examination (including intraoral photographs, panoramic radiograph, and cephalometric analysis) | 1 | ₦45,000 | ₦45,000 |
| 2 | Dental Impressions & Digital Scan for Custom Appliance Fabrication | 1 | ₦35,000 | ₦35,000 |
| 3 | Prophylaxis (Professional Scaling & Polishing) – Pre-Orthodontic Preparation | 1 | ₦28,000 | ₦28,000 |
| 4 | Placement of Fixed Metal Braces (Upper & Lower Arch) – Includes brackets, archwires, bands, and bonding agents | 1 | ₦350,000 | ₦350,000 |
| 5 | Monthly Orthodontist Adjustment & Review Visits (18-month treatment duration) | 18 | ₦15,000 | ₦270,000 |
| 6 | Interproximal Reduction (IPR) / Enamel Stripping (if clinically indicated) | 1 | ₦40,000 | ₦40,000 |
| 7 | Removal of Fixed Appliances & Final Archwire Removal | 1 | ₦30,000 | ₦30,000 |
| 8 | Retention Appliance Fabrication (Hawley Retainers – Upper & Lower) | 2 | ₦45,000 | ₦90,000 |
| 9 | Post-Orthodontic Follow-Up & Retainer Adjustment (6 months) | 6 | ₦10,000 | ₦60,000 |
| 10 | Emergency Orthodontist Visit (Bracket/Wire Repair) – Estimated allowance | 2 | ₦12,000 | ₦24,000 |
| SUBTOTAL | ₦972,000 | |||
| VAT (7.5%) | ₦72,900 | |||
| GRAND TOTAL | ₦1,044,900 | |||
In line with standard practice at our Nigeria Lagos orthodontic clinic, the total amount of ₦1,044,900 (One Million, Forty-Four Thousand, Nine Hundred Naira Only) may be settled as follows:
| Payment Milestone | Amount (NGN) | Due Date |
|---|---|---|
| Initial Deposit (upon acceptance of this Quotation Estimate) | ₦261,225 (25%) | Within 5 working days of acceptance |
| Second Installment (at 6-month treatment mark) | ₦261,225 (25%) | December 2025 |
| Third Installment (at 12-month treatment mark) | ₦261,225 (25%) | June 2026 |
| Final Balance (upon appliance removal) | ₦261,225 (25%) | December 2026 |
Payment may be made via bank transfer to GTBank – Lagos Smile Orthodontic Centre – Account No: 0123 4567 89, or by debit/credit card at the clinic reception. A receipt will be issued for every payment received.
4. TERMS AND CONDITIONS- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Orthodontist reserves the right to revise pricing due to changes in material costs or exchange rate fluctuations affecting imported orthodontic supplies in Nigeria Lagos.
- All orthodontic treatment is performed under the direct supervision of Dr. Funke Adebayo, a registered Orthodontist with the Medical and Dental Council of Nigeria (MDCN) and the Nigerian Orthodontic Society (NOS).
- The patient agrees to attend all scheduled adjustment appointments. Missed appointments beyond two (2) consecutive visits may result in a rescheduling fee of ₦5,000 per occurrence.
- Orthodontic treatment outcomes are individual. While the Orthodontist will exercise the highest standard of clinical care, the final aesthetic and functional result may vary based on patient compliance, oral hygiene, and biological response.
- The patient is responsible for maintaining excellent oral hygiene throughout the treatment period. Damage to brackets or wires caused by the patient's negligence (e.g., biting hard objects) will incur a separate repair charge not covered by this Quotation Estimate.
- Any additional procedures not foreseen at the time of this Quotation Estimate will be communicated in writing and require the patient's written consent before commencement.
- This Quotation Estimate does not constitute a binding contract until the initial deposit is received and the patient signs the acceptance form provided at our Nigeria Lagos clinic.
- All records, radiographs, and digital scans generated during treatment are the property of Lagos Smile Orthodontic Centre and will be retained for a minimum of seven (7) years in compliance with Nigerian health data regulations.
- Disputes arising from this Quotation Estimate or the services rendered shall be resolved amicably. In the event of unresolved disagreement, the matter shall be referred to the Medical and Dental Council of Nigeria, Lagos State Chapter, for mediation.
By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the scope of Orthodontist services to be provided, and agrees to the payment schedule and terms outlined above.
Patient / Guardian SignatureName: Adewale O. Okonkwo
Date: _______________ Orthodontist / Authorised Representative
Name: Dr. Funke Adebayo, MDS (Ortho)
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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