Quotation Estimate Orthodontist in Spain Barcelona –Free Word Template Download with AI

Clinic: Clínica Ortodòntica Barcelona
Address: Passeig de Gràcia, 142, 08008 Barcelona, Spain
Phone: +34 93 214 5678
Email: [email protected]
NIF: B-65432109 Patient Name: [Full Name]
NIE/DNI: [Identification Number]
Address: [Patient Address], Barcelona, Spain
Phone: [Patient Phone]
Email: [Patient Email] 1. QUOTATION ESTIMATE SUMMARY

This Quotation Estimate has been prepared by our licensed Orthodontist at Clínica Ortodòntica Barcelona, located in the heart of Spain Barcelona, following a comprehensive clinical examination and diagnostic evaluation of the patient. This document outlines the proposed orthodontic treatment plan, the associated costs, and the financial terms applicable to the care to be delivered at our practice in Barcelona, Spain. All prices are expressed in Euros (€) and include the applicable Value Added Tax (VAT / IVA) at the current rate of 21% as regulated by the Spanish tax authorities (Agencia Tributaria).

2. DIAGNOSTIC FINDINGS & TREATMENT RECOMMENDATION

Following a full clinical assessment, panoramic radiograph (OPG), cephalometric analysis, intraoral photographs, and digital impressions performed by our senior Orthodontist Dr. Marta Vidal (Col. Col. Odontòlegs de Catalunya, No. 12345), the following conditions have been identified: Class II malocclusion with anterior crossbite on the left side, moderate crowding in the upper arch, and a midline deviation of 2.5 mm. The recommended treatment protocol involves comprehensive fixed orthodontic appliance therapy with a projected duration of 24 to 30 months, followed by a retention phase of 18 months.

3. DETAILED QUOTATION ESTIMATE – LINE ITEMS

No.	Description of Service	Unit	Unit Price (€)	Subtotal (€)	Notes
1	Initial Consultation & Diagnostic Study (clinical exam, OPG, cephalometric X-ray, intraoral photos, digital scan)	1 session	180.00	180.00	One-time fee
2	Comprehensive Fixed Orthodontic Appliance – Ceramic Braces (upper & lower arches), including bonding, monthly adjustments, and all brackets, wires, and elastics	24–30 months	4,200.00	4,200.00	Includes all routine visits
3	Interproximal Reduction (IPR) – selective enamel stripping for space creation	Per session (est. 4 sessions)	95.00	380.00	As clinically required
4	Orthodontic Mini-Implants (TADs) – placement and removal (up to 4 units)	4 units	250.00	1,000.00	For anchorage control
5	Post-Treatment Retention – Fixed lingual retainers (upper & lower) + 2 removable Essix retainers	1 set	650.00	650.00	18-month retention
6	Emergency / Unscheduled Visits (up to 3 per treatment year)	3 visits	60.00	180.00	Additional visits billed separately
7	Final Radiographic & Photographic Documentation (post-treatment records)	1 session	120.00	120.00	For medical records
TOTAL QUOTATION ESTIMATE (VAT 21% included)				6,710.00	—

4. PAYMENT TERMS & FINANCING OPTIONS

This Quotation Estimate may be settled through the following payment structures, all of which are available to patients receiving orthodontic care in our Spain Barcelona practice:

Full Payment: 100% of the total amount due at the time of appliance placement. A 5% discount (€335.50) is applied for full upfront payment, reducing the total to €6,374.50.
Installment Plan (0% interest): The total amount may be divided into 24 equal monthly installments of €279.58, with no additional interest or administrative fees. A 20% deposit (€1,342.00) is required at the initial consultation to commence treatment.
Insurance / Mutual Coverage: If the patient holds a Spanish health insurance policy (e.g., Adeslas, DKV, Sanitas, Asisa) that includes orthodontic coverage, our Orthodontist team will submit the claim directly. The patient is responsible for any co-payment or deductible not covered by the insurer.

5. TERMS & CONDITIONS

This Quotation Estimate is valid for a period of 90 days from the date of issue. After this period, prices may be subject to revision in accordance with the current fee schedule of the Orthodontist practice and applicable regulations in the Community of Catalonia, Spain.
The total treatment duration of 24–30 months is an estimate based on current clinical findings. The treating Orthodontist reserves the right to adjust the treatment timeline based on the patient's biological response and compliance with instructions.
All orthodontic appointments must be scheduled at least 48 hours in advance. Cancellations made less than 24 hours before the appointment may incur a fee of €50.00.
The patient agrees to attend all scheduled review appointments at the clinic located in Spain Barcelona (Passeig de Gràcia, 142, 08008) and to follow all post-treatment care instructions provided by the Orthodontist.
In the event of appliance damage caused by the patient (e.g., broken bracket, detached wire), a repair fee of €40.00 per incident will apply, in addition to any materials required.
This Quotation Estimate does not include the cost of any pre-orthodontic extractions, periodontal treatment, or restorative dentistry that may be required prior to or during orthodontic therapy. Such procedures will be quoted separately.
All personal data processed in connection with this Quotation Estimate and subsequent treatment will be handled in strict compliance with the European General Data Protection Regulation (GDPR) and the Spanish Organic Law 3/2018 on Personal Data Protection (LOPDGDD).
Any disputes arising from this Quotation Estimate or the orthodontic treatment provided shall be subject to the jurisdiction of the competent courts of Barcelona, Spain, in accordance with the applicable provisions of the Spanish Civil Code and the Ley de Ordenación de las Profesiones Sanitarias (LOPS).

6. ACCEPTANCE & SIGNATURES

By signing below, the patient acknowledges having received and reviewed this Quotation Estimate, understands the proposed orthodontic treatment plan as explained by the Orthodontist, and agrees to the financial terms and conditions set forth in this document. The patient confirms that all information provided regarding the expected duration, costs, and potential risks of the treatment has been clearly communicated in a language the patient fully understands.

Patient Signature
Name: ______________________________
Date: ______________________________ Orthodontist / Clinic Representative
Dr. Marta Vidal, Col. No. 12345
Clínica Ortodòntica Barcelona, Spain
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX

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