Quotation Estimate Orthodontist in Saudi Arabia Riyadh –Free Word Template Download with AI
Orthodontist Professional Services — Saudi Arabia, Riyadh
Al-Nakheel Orthodontic & Dental Center • Riyadh, Saudi Arabia
Provider: Al-Nakheel Orthodontic & Dental CenterAddress: King Fahd Road, Al Olaya District, Riyadh 12212, Saudi Arabia
Phone: +966 11 456 7890
Email: [email protected]
CR No.: 1010XXXXXX • MOH License: 2024-ORT-00452 Prepared By: Dr. Sarah Al-Rashid, DDS, MSc (Orthodontics)
Specialty: Orthodontist — Braces, Aligners, Jaw Alignment
License No.: MOH-ORT-2019-8834
Member: Saudi Orthodontic Society Quotation Estimate No.: QE-2025-07842
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 (30 days) Client Name: Mr. Abdullah Al-Otaibi
Client Address: Al Malqa District, Riyadh, Saudi Arabia
Client Phone: +966 5X XXX XXXX
Client ID (Iqama/CR): 10XX-XXXXXX-XX
This Quotation Estimate is issued by Al-Nakheel Orthodontic & Dental Center, a licensed and accredited orthodontic practice located in the heart of Riyadh, Saudi Arabia. The following itemized breakdown details the complete orthodontic treatment plan recommended by our senior Orthodontist, Dr. Sarah Al-Rashid, following a comprehensive clinical examination, digital panoramic radiography, intraoral scanning, and cephalometric analysis performed on 10 June 2025. All pricing is quoted in Saudi Riyals (SAR) and is inclusive of applicable Value Added Tax (VAT) at 15% as mandated by the Zakat, Tax and Customs Authority (ZATCA) of Saudi Arabia.
| # | Service / Procedure | Description | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Diagnostic Workup | Comprehensive clinical exam, digital OPG, cephalometric X-ray, intraoral 3D scan, treatment planning session | 1 | 850.00 | 850.00 |
| 2 | Pre-Orthodontic Periodontal & Restorative Treatment | Scaling, root planing, composite fillings (2 units), and extraction of tooth #48 (wisdom tooth) under local anesthesia | 1 | 2,400.00 | 2,400.00 |
| 3 | Fixed Orthodontic Appliance Placement (Ceramic Braces) | Full-arch ceramic bracket system (upper & lower), archwire ligation, elastic placement, and initial adjustment by the Orthodontist | 1 | 18,500.00 | 18,500.00 |
| 4 | Monthly Orthodontic Adjustment Visits | Archwire changes, elastic replacement, torque adjustments, and progress monitoring by the supervising Orthodontist in Riyadh | 18 | 650.00 | 11,700.00 |
| 5 | Interproximal Reduction (IPR) & Space Management | Minimal enamel reduction for crowding resolution, performed by the Orthodontist during adjustment visits | 1 | 1,200.00 | 1,200.00 |
| 6 | Debonding & Finishing | Removal of all brackets and wires, polishing, and final occlusal adjustment | 1 | 1,500.00 | 1,500.00 |
| 7 | Retainer Fabrication (Hawley & Clear) | One Hawley retainer (upper) and one clear vacuum-formed retainer (lower), including two sets of replacement elastics | 1 | 1,800.00 | 1,800.00 |
| 8 | Post-Treatment Follow-Up & Retainer Checks | Three follow-up appointments at 3, 6, and 12 months post-debonding to monitor stability in Riyadh | 3 | 350.00 | 1,050.00 |
| 9 | Emergency Orthodontic Visit (Contingency) | One complimentary emergency visit for bracket debond, wire irritation, or appliance damage during active treatment | 1 | 0.00 | 0.00 |
| Subtotal (SAR) | 38,000.00 | ||||
| VAT @ 15% (SAR) | 5,700.00 | ||||
| GRAND TOTAL (SAR) | 43,700.00 | ||||
- This Quotation Estimate for Orthodontist services is issued exclusively for the named client and is non-transferable. It is prepared in compliance with the regulations of the Saudi Ministry of Health (MOH) and the Saudi Food & Drug Authority (SFDA) guidelines for dental and orthodontic practices in Riyadh, Saudi Arabia.
- Payment Schedule: A 30% deposit (SAR 13,110.00) is due upon acceptance of this Quotation Estimate to secure the treatment slot. The remaining balance shall be paid in three equal installments at months 6, 12, and 18 of active treatment. All payments are accepted via bank transfer, SADAD, or approved credit/debit cards.
- The client agrees to attend all scheduled Orthodontist adjustment appointments at the Al-Nakheel clinic in Riyadh. Missed appointments beyond 48 hours without rescheduling may incur a no-show fee of SAR 350.00 per occurrence.
- Warranty: The Orthodontist and the clinic provide a 12-month warranty on all orthodontic appliances against manufacturing defects. Normal wear, patient-induced damage, or failure to follow retainer protocols voids the warranty.
- Confidentiality: All patient records, radiographic images, and treatment plans are handled in strict accordance with Saudi Arabia's Personal Data Protection Law (PDPL) and the MOH patient privacy regulations.
- Any additional procedures not listed in this Quotation Estimate (e.g., orthognathic surgery referral, additional extractions, or extended treatment beyond 24 months) will be quoted separately with written client consent prior to commencement.
- This Quotation Estimate does not constitute a binding contract until signed and countersigned by both parties. The final treatment plan may be modified by the Orthodontist based on clinical progress, and any such modifications will be communicated in writing.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the Kingdom of Saudi Arabia, with jurisdiction vested in the competent courts of Riyadh.
Dr. Sarah Al-Rashid, DDS, MSc
Lead Orthodontist
Al-Nakheel Orthodontic & Dental Center
Riyadh, Saudi Arabia
Date: _______________ Accepted & Approved By (Client)
Mr. Abdullah Al-Otaibi
Signature: _______________
Date: _______________
ID No.: _______________ ⬇️ Download as DOCX Edit online as DOCX
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