Quotation Estimate Orthodontist in Philippines Manila –Free Word Template Download with AI
Orthodontist Professional Services — Philippines Manila
Official Estimate DocumentDr. Maria C. Santos, DDS, MS
Santos Orthodontics & Dental Center
128 Makati Avenue, 3rd Floor
Salcedo Village, Makati City
Philippines Manila, 1230
Tel: (+63) 2 8881-4567
Email: [email protected]
Quotation Details
Quotation No.: QE-2025-0714-0032
Date Issued: July 14, 2025
Valid Until: August 14, 2025
Prepared By: Dr. Maria C. Santos
Specialty: Orthodontist — Braces, Aligners, Jaw Alignment
| Client / Patient Name: | Mr. Juan R. Dela Cruz |
| Address: | 45 Bonifacio Drive, BGC, Taguig City, Philippines Manila |
| Contact Number: | (+63) 917 555-8823 |
| Referring Physician: | Dr. Antonio Reyes, DDS (General Dentistry, Quezon City) |
| Diagnosis / Treatment Plan: | Class II Malocclusion with moderate crowding; full-arch orthodontic correction recommended |
This Quotation Estimate outlines the complete scope of orthodontic treatment to be performed by our licensed Orthodontist in the Philippines Manila area. All prices are quoted in Philippine Pesos (PHP) and are inclusive of standard materials. The following itemization reflects the comprehensive treatment plan developed after a full clinical and radiographic examination conducted on July 10, 2025.
| No. | Service / Procedure Description | Frequency | Duration | Amount (PHP) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Comprehensive Examination (includes panoramic X-ray, intraoral photographs, digital study models, and cephalometric analysis) | One-time | 60 minutes | PHP 3,500.00 |
| 2 | Full-Mouth Digital Impression & Treatment Plan Formulation by the Orthodontist | One-time | 45 minutes | PHP 2,800.00 |
| 3 | Placement of Metal Braces — Upper and Lower Arch (includes brackets, bands, archwires, and elastic ligatures) | One-time | 90 minutes | PHP 45,000.00 |
| 4 | Monthly Orthodontic Adjustment Visits (wire changes, elastic replacements, progress monitoring, and minor tooth movement corrections) | 22 months | 30 min each | PHP 1,800.00 / visit (Total: PHP 39,600.00) |
| 5 | Interproximal Reduction (IPR) — selective enamel stripping for crowding relief | As needed (est. 4 sessions) | 20 min each | PHP 1,200.00 / session (Total: PHP 4,800.00) |
| 6 | Removable Retainer Fabrication (upper and lower Hawley retainers) — post-debonding phase | One-time | 30 minutes | PHP 6,500.00 |
| 7 | Post-Treatment Follow-Up & Retainer Check-ups (6-month intervals for the first year, then annually) | 4 visits (Year 1) | 20 min each | PHP 800.00 / visit (Total: PHP 3,200.00) |
| 8 | Emergency Orthodontic Visit (broken bracket, wire irritation, or urgent adjustment) — included in package | Up to 3 visits | 20 min each | PHP 0.00 (Included) |
| Subtotal (Items 1–8): | PHP 105,400.00 |
| VAT (12%): | PHP 12,648.00 |
| Discount (Early Commitment — 5%): | - PHP 5,270.00 |
| GRAND TOTAL: | PHP 112,778.00 |
This Quotation Estimate for Orthodontist services in Philippines Manila may be settled through the following payment schedule, subject to the patient's preference and financial capability:
- Down Payment (upon acceptance): PHP 30,000.00 — covers initial consultation, digital impressions, and brace placement.
- Monthly Installments: PHP 4,500.00 per month for 22 months, covering adjustment visits and ongoing orthodontic care.
- Final Balance (upon debonding): PHP 18,278.00 — covers retainer fabrication and remaining balance.
Accepted payment methods include cash, bank transfer (BDO, BPI, Metrobank), credit/debit cards (Visa, Mastercard), and in-house installment plans. A 1.5% convenience fee applies to credit card transactions.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After the validity period, pricing may be subject to revision based on material costs and the Orthodontist's updated fee schedule in the Philippines Manila dental community.
- All orthodontic procedures will be performed or directly supervised by Dr. Maria C. Santos, a board-certified Orthodontist registered with the Philippine Board of Dentistry and the Philippine Orthodontic Society (PHOS).
- The estimated treatment duration of twenty-two (22) months is a clinical projection. Actual duration may vary by two to four months depending on individual tooth response, patient compliance with elastic wear, and any unforeseen complications.
- Patient is responsible for maintaining oral hygiene throughout the orthodontic treatment. Failure to attend scheduled adjustment visits for more than two consecutive months may result in a re-engagement fee of PHP 2,000.00.
- Any additional procedures not listed in this Quotation Estimate (e.g., orthognathic surgery referral, periodontal treatment, or restorative work) will be quoted separately and require written patient consent before commencement.
- This estimate does not cover hospitalization, general anesthesia, or emergency dental care unrelated to the orthodontic appliance.
- All services are rendered at the Santos Orthodontics & Dental Center located in Makati City, Philippines Manila. Travel or accommodation expenses for the patient are not included.
- Confidentiality of all patient records, radiographs, and treatment plans is maintained in accordance with the Philippine Data Privacy Act of 2012 (RA 10173).
- By signing below, the patient acknowledges receipt and understanding of this Quotation Estimate and agrees to the terms stated herein. This document does not constitute a binding contract until the down payment is received and a separate Treatment Consent Form is executed.
Prepared by:
Dr. Maria C. Santos, DDS, MSLead Orthodontist
Santos Orthodontics & Dental Center
Philippines Manila
Accepted by (Patient / Guardian):
Mr. Juan R. Dela CruzSignature / Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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