Quotation Estimate Orthodontist in Singapore Singapore –Free Word Template Download with AI
Licensed Orthodontist Practice | 12 Marina Boulevard, Level 8, Singapore Singapore 018982
Tel: +65 6888 4520 | Email: [email protected] | UEN: 201912345K
Quotation EstimateQuotation Estimate Details
Quotation Estimate No.: QE-2025-0847
Date of Issue: 15 June 2025
Valid Until: 15 July 2025
Prepared By: Dr. Tan Wei Ming, Orthodontist
Practice Location: Singapore Singapore
Client Information
Name: [Patient Full Name]
NRIC / Passport No.: [S1234567A]
Contact Number: +65 9XXX XXXX
Email: [[email protected]]
Address: [Residential Address], Singapore Singapore
Dear Patient,
Thank you for visiting our Orthodontist practice at Singapore Singapore Orthodontic Centre. Following your comprehensive consultation and clinical assessment conducted on 10 June 2025, we are pleased to present this Quotation Estimate outlining the full scope of orthodontic treatment recommended by our senior Orthodontist, Dr. Tan Wei Ming. This Quotation Estimate has been prepared in accordance with the standards set by the Singapore Dental Council and reflects the current fee schedule of our Orthodontist clinic located in the heart of Singapore Singapore.
Itemised Quotation Estimate Breakdown| No. | Description of Orthodontic Service | Frequency | Unit Price (SGD) | Estimated Total (SGD) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Diagnostic Records (X-rays, OPG, panoramic radiograph, intraoral photographs, digital impressions) | One-time | $380.00 | $380.00 |
| 2 | Comprehensive Treatment Planning by Senior Orthodontist (includes 3D digital treatment simulation and case presentation) | One-time | $250.00 | $250.00 |
| 3 | Placement of Fixed Metal Braces (upper and lower arches, including bonding of brackets, archwires, and elastic ligatures) | One-time | $4,800.00 | $4,800.00 |
| 4 | Monthly Orthodontic Adjustment Appointments (wire changes, elastic adjustments, bracket re-bonding if required) | 18 months | $180.00 | $3,240.00 |
| 5 | Removable Retainer Fabrication (upper and lower, including one replacement set within 12 months) | One-time | $650.00 | $650.00 |
| 6 | Post-Treatment Orthodontic Review (6-month and 12-month follow-up assessments by the Orthodontist) | 2 sessions | $120.00 | $240.00 |
| 7 | Emergency Orthodontic Appointment (if required during active treatment, e.g., broken bracket or wire irritation) | As needed | $150.00 | $150.00 |
| TOTAL ESTIMATED COST (SGD) | $9,710.00 | |||
- This Quotation Estimate is valid for thirty (30) days from the date of issue. Beyond this period, the Orthodontist reserves the right to revise the fees in accordance with the updated fee schedule of Singapore Singapore Orthodontic Centre.
- A non-refundable deposit of twenty percent (20%) of the total Quotation Estimate amount, amounting to SGD $1,942.00, is required to secure the patient's treatment slot with our Orthodontist and to commence the treatment plan.
- The remaining balance shall be payable in equal monthly instalments over the duration of the active orthodontic treatment period (approximately 18 months), or in full at the time of appliance placement, at the patient's discretion.
- Accepted payment methods include cash, NETS, credit/debit cards (Visa, Mastercard, American Express), PayNow, and bank transfer. All transactions are processed in Singapore Dollars (SGD) at our clinic in Singapore Singapore.
- Should the patient discontinue treatment before completion, a cancellation fee of SGD $500.00 will be applicable, in addition to any outstanding balances for services already rendered by the Orthodontist.
- All orthodontic records, radiographs, and digital impressions obtained during the course of treatment are the property of Singapore Singapore Orthodontic Centre. A copy may be provided to the patient upon written request.
- This Quotation Estimate does not constitute a guarantee of specific aesthetic or functional outcomes. The Orthodontist will use reasonable clinical judgement and best practice in delivering the recommended treatment in Singapore Singapore.
- The patient consents to the treatment plan as outlined in this Quotation Estimate and acknowledges that the Orthodontist has explained the risks, benefits, and alternative options available.
- Any additional procedures not included in this Quotation Estimate (e.g., orthognathic surgery referral, periodontal treatment, or extraction of teeth) will be subject to a separate Quotation Estimate and prior written consent from the patient.
- This Quotation Estimate is governed by the laws of the Republic of Singapore. Any disputes arising from this document shall be subject to the exclusive jurisdiction of the courts in Singapore Singapore.
By signing below, the patient confirms that they have read, understood, and accepted the terms and conditions set forth in this Quotation Estimate. The patient further acknowledges that the Orthodontist at Singapore Singapore Orthodontic Centre has provided a thorough explanation of the proposed treatment plan, associated costs, and expected duration of care.
Patient / Guardian Signature:
Name: ______________________________
Date: ______________________________
Orthodontist / Authorised Representative:
Dr. Tan Wei Ming, Orthodontist
Singapore Singapore Orthodontic Centre
Date: ______________________________
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