Quotation Estimate Orthodontist in Spain Madrid –Free Word Template Download with AI
Orthodontic Treatment Plan & Financial Estimate
Spain Madrid Clínica Ortodóntica Madrid CentralDr. Alejandro Fernández Ruiz, Orthodontist
Calle de Serrano, 142, 28006 Madrid, Spain
Tel: +34 91 555 2347
Email: [email protected]
NIF: B-87654321
Col. Nº 28/12345 (Ilustre Colegio Oficial de Odontólogos y Estomatólogos de Madrid) Client Information
Name: María García López
Address: Av. de la Paz, 87, 3ºB
28010 Madrid, Spain
DNI: 45.678.912-X
Tel: +34 612 345 678
Email: [email protected]
Following a comprehensive clinical examination, radiographic analysis (panoramic X-ray, cephalometric study, and intraoral digital scans), and a detailed consultation conducted at our orthodontic clinic in the Salamanca district of Madrid, Spain, the following treatment plan has been developed for the patient. The diagnosis indicates a Class II malocclusion with moderate crowding in the upper and lower arches, a midline deviation of 1.5 mm, and a deep overbite of 4 mm. The recommended orthodontic intervention involves a combination of fixed ceramic braces on the upper arch and a self-ligating system on the lower arch, supplemented by interproximal reduction (IPR) and the placement of two mini-implants (TADs) for anchorage control.
| Ref | Description of Orthodontic Service | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 01 | Initial consultation, clinical examination, and digital diagnostic records (intraoral scan, panoramic radiograph, cephalometric X-ray, and photographic documentation) | 1 | € 120.00 | € 120.00 |
| 02 | Comprehensive treatment planning session with 3D digital simulation (Invisalign-style preview) and patient consultation in Madrid | 1 | € 95.00 | € 95.00 |
| 03 | Placement of fixed ceramic (tooth-coloured) brackets – upper arch (16 brackets, bonding, and adjustment) | 1 | € 1,850.00 | € 1,850.00 |
| 04 | Placement of self-ligating metal brackets – lower arch (16 brackets, bonding, and adjustment) | 1 | € 1,450.00 | € 1,450.00 |
| 05 | Interproximal reduction (IPR) – up to 12 surfaces for space creation | 1 | € 320.00 | € 320.00 |
| 06 | Placement of two temporary anchorage devices (TADs / mini-implants) for skeletal anchorage | 2 | € 280.00 | € 560.00 |
| 07 | Monthly orthodontic adjustment visits (wire changes, elastic changes, bracket re-bonding if required) – estimated 24 sessions over 24 months | 24 | € 85.00 | € 2,040.00 |
| 08 | Removal of all orthodontic appliances, final bonding, and delivery of fixed and removable retainers (upper and lower) | 1 | € 480.00 | € 480.00 |
| 09 | Post-treatment follow-up reviews (6 months, 12 months, 24 months) including retainer adjustments and radiographic checks | 3 | € 60.00 | € 180.00 |
| 10 | Emergency / urgent orthodontic appointments (broken bracket, wire irritation, etc.) – included up to 3 visits | 3 | € 0.00 | € 0.00 |
| Subtotal (before tax) | € 7,095.00 |
| IVA (VAT) – 21% (Spain, Madrid) | € 1,489.95 |
| GRAND TOTAL (Quotation Estimate) | € 8,584.95 |
This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. The total amount of € 8,584.95 (inclusive of 21% IVA applicable in Spain) may be settled through the following options:
- Option A – Full Payment: 100% at the commencement of treatment. A 5% discount (€ 429.25) will be applied, reducing the total to € 8,155.70.
- Option B – Installment Plan: 20% deposit (€ 1,716.99) at the start of treatment, followed by 23 equal monthly payments of € 308.00 over the treatment period. No additional interest is charged.
- Option C – Financing: Through our partner bank (CaixaBank / BBVA) with 0% interest for up to 36 months. Subject to credit approval in Spain.
Terms of this Quotation Estimate
- This Quotation Estimate is a financial projection based on the current clinical findings. The final cost may vary by up to ±10% depending on the actual treatment progression, additional procedures that may become necessary, or changes in the treatment plan agreed upon by the Orthodontist and the patient.
- All prices are quoted in Euros (EUR) and include the 21% Value Added Tax (IVA) as regulated by the Spanish tax authority (Agencia Estatal de Administración Tributaria – AEAT) for the community of Madrid.
- This estimate does not cover the cost of any pre-existing dental work (fillings, extractions, periodontal treatment, or restorative dentistry) that may be required prior to or during orthodontic treatment. Such services will be quoted separately.
- The estimated treatment duration of 24 months is an average projection. Individual results may vary, and the Orthodontist reserves the right to extend or shorten the treatment period based on clinical progress.
- The patient is responsible for maintaining good oral hygiene throughout the treatment. Failure to attend scheduled appointments may result in additional fees or treatment delays.
- This Quotation Estimate is non-transferable and is issued exclusively for the named patient at Clínica Ortodóntica Madrid Central, located in the city of Madrid, Spain.
- In the event of early discontinuation of treatment, a cancellation fee of 15% of the remaining balance will be applied.
- Compliance with all applicable Spanish healthcare regulations, data protection laws (RGPD / GDPR), and the professional code of ethics of the Ilustre Colegio Oficial de Odontólogos y Estomatólogos de Madrid is guaranteed.
By signing below, the patient acknowledges that they have received and reviewed this Quotation Estimate for orthodontic treatment, that all terms and conditions have been explained in clear terms, and that they authorize the Orthodontist to proceed with the treatment plan as described. The patient confirms that they have had the opportunity to ask questions and that all information regarding the expected outcomes, risks, and alternatives has been provided in accordance with Spanish informed consent legislation.
Patient SignatureMaría García López
Date: _______________ Orthodontist Signature
Dr. Alejandro Fernández Ruiz
Col. Nº 28/12345
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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