Quotation Estimate Orthodontist in South Korea Seoul –Free Word Template Download with AI
Orthodontist Professional Services — South Korea Seoul
Document No. QTE-SEO-2025-04871The following Quotation Estimate outlines the comprehensive orthodontic treatment plan prepared by our licensed Orthodontist at Seoul Premier Orthodontic Center, located in the heart of South Korea Seoul. All pricing reflects current 2025 fee schedules and includes applicable diagnostic imaging, consultation, and follow-up appointments.
| No. | Service / Procedure | Frequency / Duration | Unit Price (KRW) | Total (KRW) | Notes |
|---|---|---|---|---|---|
| 1 | Initial Orthodontist Consultation & Comprehensive Diagnostic Evaluation (Panoramic X-ray, Cephalometric Analysis, Intraoral Scanning, Clinical Photography) | One-time | &won;180,000 | &won;180,000 | Includes 3D digital model |
| 2 | Fixed Orthodontic Appliance Placement (Ceramic Braces — Upper & Lower Arch) | One-time | &won;2,400,000 | &won;2,400,000 | 3M Clarity Ceramic system |
| 3 | Monthly Orthodontist Adjustment & Wire Change Appointments | 18 months | &won;120,000 | &won;2,160,000 | Every 4–6 weeks |
| 4 | Interproximal Reduction (IPR) & Minor Tooth Contouring (as clinically indicated) | As needed | &won;80,000 | &won;320,000 | Estimated 4 sessions |
| 5 | Removable Retainer Fabrication (Hawley & Clear Essix — Upper & Lower) | One-time | &won;350,000 | &won;350,000 | Post-debonding |
| 6 | Annual Retainer Check-up & Re-fabrication (Year 1 & Year 2) | 2 years | &won;100,000 | &won;200,000 | Includes minor adjustments |
| 7 | Emergency Orthodontist Visit (Broken bracket, wire irritation — up to 2 visits) | Contingency | &won;50,000 | &won;100,000 | Charged only if used |
| 8 | Periodontal Screening & Professional Cleaning (Pre-treatment & Mid-treatment) | 2 sessions | &won;90,000 | &won;180,000 | Required before bonding |
| TOTAL ESTIMATED COST (Quotation Estimate) | &won;5,890,000 | ||||
1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing may be subject to revision in accordance with the Orthodontist practice's updated fee schedule for South Korea Seoul.
2. Payment Schedule: A 20% deposit (&won;1,178,000) is due upon acceptance of this Quotation Estimate to secure the appointment slot. The remaining balance shall be paid in three equal installments at months 1, 9, and 18 of the treatment period. All payments are accepted in Korean Won (KRW) via bank transfer, credit card, or cash at the Seoul clinic.
3. Cancellation Policy: Should the patient cancel the orthodontic treatment after the initial consultation but before appliance placement, the deposit will be refunded less a &won;100,000 administrative fee. Cancellations after appliance placement are non-refundable for work already performed.
4. Insurance & Reimbursement: The Orthodontist at Seoul Premier Orthodontic Center is registered with the Korean National Health Insurance (NHI) system. Eligible portions of this Quotation Estimate may be submitted for partial reimbursement. The patient is responsible for any co-payments and for the full amount of cosmetic or non-covered orthodontic procedures.
5. Treatment Duration: The estimated treatment duration of 18 months is based on the Orthodontist's clinical assessment. Actual duration may vary. The Orthodontist will communicate any anticipated changes in timeline at each adjustment visit.
6. Compliance: The patient agrees to attend all scheduled Orthodontist appointments in Seoul, maintain oral hygiene as instructed, and report any appliance damage within 48 hours. Failure to comply may extend treatment and incur additional fees not covered by this Quotation Estimate.
7. Governing Law: This Quotation Estimate and any resulting treatment agreement shall be governed by the laws of the Republic of Korea. Disputes shall be resolved through the Seoul Medical Dispute Mediation Center.
8. Confidentiality: All patient records, diagnostic images, and treatment plans are protected under the Korean Personal Information Protection Act (PIPA). The Orthodontist practice in South Korea Seoul shall not disclose patient information without written consent.
| Patient / Guardian Signature | Orthodontist (Dr. Min-Ji Park) Signature |
|---|---|
|
Name: ____________________________ Date: ____________________________ |
Seal / Signature: ____________________________ Date: ____________________________ |
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