Quotation Estimate Orthodontist in South Africa Johannesburg –Free Word Template Download with AI
Dr. Thandiwe Mokoena, Orthodontist
142 Rivonia Road, Sandton, Johannesburg, 2196, South Africa
Telephone: +27 (0)11 456 7890 | Email: [email protected]
HPCSA Registration No: 0012345678 | Fidelity Fund Certificate: 2024/0098765
Quotation Estimate Details
Quotation Estimate No: QE-2025-04871
Date of Issue: 14 June 2025
Valid Until: 14 July 2025 (30 days)
Currency: South African Rand (ZAR)
Prepared By: Dr. T. Mokoena, Orthodontist
Client Information
Client Name: Mr. James van der Merwe
ID Number: 8503125009087
Address: 28 Oak Avenue, Fourways, Johannesburg, 2191, South Africa
Medical Aid: Discovery Health (Ortho Plan)
Member No: DH-44782910
Scope of Orthodontic Services – Quotation Estimate BreakdownThis Quotation Estimate has been prepared by our Orthodontist practice in Johannesburg, South Africa, following a comprehensive clinical assessment conducted on 10 June 2025. The following itemised costs reflect the full scope of orthodontic treatment recommended for the client. All prices are quoted in South African Rand (ZAR) and are inclusive of VAT at 15% as per South African tax regulations.
| Ref | Description of Orthodontic Service | Duration / Frequency | Unit Cost (ZAR) | Total (ZAR) |
|---|---|---|---|---|
| 01 | Initial Orthodontic Consultation & Diagnostic Records (X-rays, panoramic radiograph, intraoral photographs, digital impressions) | One-time | R 2,850.00 | R 2,850.00 |
| 02 | Orthodontic Treatment Plan Formulation & Digital Smile Design (by Orthodontist) | One-time | R 1,200.00 | R 1,200.00 |
| 03 | Placement of Self-Ligating Ceramic Braces (Upper & Lower Arch) | One-time | R 18,500.00 | R 18,500.00 |
| 04 | Monthly Orthodontic Adjustment Visits (bracket checks, wire changes, elastic replacements) | 18 months | R 1,450.00 | R 26,100.00 |
| 05 | Interproximal Reduction (IPR) – selective enamel stripping for space creation | As required (est. 4 sessions) | R 650.00 | R 2,600.00 |
| 06 | Removable Retainer Fabrication (Hawley type – Upper & Lower) | One-time | R 3,200.00 | R 3,200.00 |
| 07 | Post-Orthodontic Review & Retainer Adjustment (6-month intervals, Year 1) | 2 visits | R 850.00 | R 1,700.00 |
| 08 | Emergency Orthodontic Appointment (broken bracket/wire repair – included allowance) | Up to 2 visits | R 950.00 | R 1,900.00 |
| 09 | Professional Dental Hygiene & Scaling (pre-treatment and mid-treatment) | 2 sessions | R 1,100.00 | R 2,200.00 |
| 10 | Final De-bonding, Polish & Post-Treatment Records (X-rays and photographs) | One-time | R 2,400.00 | R 2,400.00 |
| SUBTOTAL (Excluding VAT) | R 62,650.00 | |||
| VAT @ 15% | R 9,397.50 | |||
| TOTAL QUOTATION ESTIMATE AMOUNT (Incl. VAT) | R 72,047.50 | |||
1. A deposit of 20% (R 14,409.50) of the total Quotation Estimate amount is due upon acceptance of this document to secure the client's treatment slot with our Orthodontist in Johannesburg, South Africa.
2. The remaining balance shall be paid in equal monthly instalments over the 18-month treatment period, amounting to R 3,446.58 per month, payable on the 1st of each month via EFT to the practice bank account.
3. Where the client's medical aid (Discovery Health Ortho Plan) provides a contribution, the practice will submit claims directly. The client is responsible for any co-payment, excess, or amounts exceeding the medical aid's orthodontic benefit limit as per their policy terms.
4. Late payments exceeding 14 days will incur a monthly interest charge of 1.5% on the outstanding balance, in accordance with the National Credit Act of South Africa.
5. This Quotation Estimate is valid for 30 days from the date of issue. Should the client wish to proceed after the validity period, the Orthodontist reserves the right to re-quote based on prevailing material and service costs in the Johannesburg, South Africa market.
6. Cancellation of treatment after the initial consultation will result in forfeiture of the deposit. Cancellation after brace placement will be subject to a pro-rata charge for materials already consumed.
7. All orthodontic services are rendered by a registered Orthodontist (HPCSA) in compliance with the Health Professions Council of South Africa (HPCSA) regulations and the National Health Act, 2003 (Act No. 61 of 2003).
8. The practice is located in Sandton, Johannesburg, South Africa, and operates Monday to Friday from 08:00 to 17:00, and Saturday from 08:00 to 13:00. Emergency orthodontic appointments may be arranged by telephone.
Client Acceptance of Quotation EstimateBy signing below, the client acknowledges that they have read, understood, and accept the terms, conditions, and costs outlined in this Quotation Estimate for orthodontic treatment provided by the Orthodontist practice in Johannesburg, South Africa. The client confirms that the treatment plan has been explained in full and that they have had the opportunity to ask questions.
Client Signature & Date
Mr. James van der Merwe
Orthodontist / Practice Representative
Dr. Thandiwe Mokoena, Orthodontist
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