Quotation Estimate Orthodontist in Spain Valencia –Free Word Template Download with AI
Reference No: QTE-VAL-2025-0487 | Date of Issue: 15 June 2025 | Valid Until: 15 September 2025
Provider (Orthodontist Practice)
Clinic Name: Clínica Dental Valencia Sonrisa
Lead Orthodontist: Dr. María Elena Serrano, COE Nº 48-12345
Address: Calle Colón 42, 2ºB, 46004 Valencia, Spain
Phone: +34 963 555 210
Email: [email protected]
VAT (NIF): B-46-8823107
Client / Patient
Name: [Patient Full Name]
Address: [Patient Address], Valencia, Spain
Phone: [Patient Phone]
Email: [Patient Email]
NIF / DNI: [Patient ID Number]
Referral Source: General Dentist – Dr. L. Ferrer
This Quotation Estimate has been prepared by our Orthodontist team at Clínica Dental Valencia Sonrisa, located in the heart of Spain Valencia, to provide the patient with a comprehensive, transparent, and itemised breakdown of all anticipated costs associated with the recommended orthodontic treatment plan. This document serves as a formal financial projection and does not constitute a binding invoice. All prices are quoted in Euros (€) and include applicable Spanish Value Added Tax (IVA) at the current rate of 21%, in full compliance with the tax regulations of the Kingdom of Spain and the autonomous community of the Valencian Community (Comunitat Valenciana).
Following a thorough clinical examination, digital panoramic radiograph (OPG), intraoral 3D scanning, and a comprehensive orthodontic consultation conducted by our senior Orthodontist in Valencia on 28 May 2025, the following diagnosis has been established: Class II malocclusion with moderate crowding in the upper and lower anterior segments, a 4 mm overjet, and a mild midline deviation. The recommended treatment approach is a fixed orthodontic appliance (ceramic brackets) combined with a post-treatment retention phase. The estimated total treatment duration is 22 to 26 months, with review appointments scheduled every 6 to 8 weeks throughout the active phase.
| Item / Service | Description | Qty | Unit Price (€) | Subtotal (€) |
|---|---|---|---|---|
| Initial Orthodontic Consultation | Comprehensive examination, OPG radiograph, 3D intraoral scan, treatment planning session with the Orthodontist in Valencia | 1 | 120.00 | 120.00 |
| Diagnostic Records & Imaging | Cephalometric radiograph, periapical films, digital photographs (12 views), study models / digital impressions | 1 | 95.00 | 95.00 |
| Fixed Ceramic Brackets – Upper Arch | 14 ceramic brackets, bonding, archwire placement, elastic ligatures | 1 | 1,450.00 | 1,450.00 |
| Fixed Ceramic Brackets – Lower Arch | 14 ceramic brackets, bonding, archwire placement, elastic ligatures | 1 | 1,450.00 | 1,450.00 |
| Monthly Adjustment Appointments | Archwire changes, elastic adjustments, progress monitoring by the Orthodontist (estimated 24 visits over 22 months) | 24 | 65.00 | 1,560.00 |
| Interproximal Reduction (IPR) | Minimal enamel reduction for crowding relief (if clinically required) | 1 | 180.00 | 180.00 |
| Post-Treatment Retainers | Two fixed lingual retainers (upper and lower) + two removable Essix retainers | 1 | 320.00 | 320.00 |
| Annual Retention Reviews (Year 1–3) | Three follow-up visits to monitor retention stability with the Orthodontist in Spain Valencia | 3 | 50.00 | 150.00 |
| Emergency / Unscheduled Visits | Provisional allowance for up to 2 unplanned visits (broken bracket, wire irritation, etc.) | 2 | 45.00 | 90.00 |
| SUBTOTAL (before IVA) | 5,415.00 | |||
| IVA (21% – Spain) | 1,137.15 | |||
| TOTAL ESTIMATED COST (incl. IVA) | 6,552.15 | |||
To ensure accessibility and financial comfort for our patients, this Quotation Estimate from our Orthodontist practice in Spain Valencia can be settled through the following payment structures:
- Full Payment: 5% discount applied to the total, bringing the final amount to €6,224.54 (incl. IVA). Payable upon placement of the first appliance.
- Installment Plan (0% interest): 24 monthly payments of €273.01 (incl. IVA), with the first payment due at appliance placement and subsequent payments on the 1st of each month.
- Financed Plan (via partner bank): 36-month term at 4.9% annual interest, coordinated through CaixaBank or Banco Santander branches in Valencia. Monthly payment approximately €198.40.
- Insurance / Mutual Coverage: If the patient holds a Spanish health mutual (e.g., Adeslas, DKV, Asisa), a portion of the orthodontic fee may be reimbursed. Our office in Valencia will assist with the submission of the Quotation Estimate and supporting clinical documentation to the insurer.
- This Quotation Estimate is valid for a period of 90 calendar days from the date of issue. After this period, prices may be subject to revision in line with the cost of materials and prevailing market conditions in Spain Valencia.
- All prices are inclusive of IVA (21%) as mandated by Spanish tax law (Ley 37/1992 del IVA). No additional hidden fees will be applied beyond those itemised above.
- The total treatment cost is an estimate. The final amount may vary slightly (±5%) depending on clinical developments during the active orthodontic phase, such as the need for additional elastics, minor tooth movement adjustments, or extended retention.
- The patient is responsible for maintaining good oral hygiene throughout treatment. Any damage to brackets or wires caused by the patient (e.g., consumption of hard or sticky foods) may incur additional repair fees not covered by this Quotation Estimate.
- Missed appointments must be rescheduled at least 48 hours in advance. Cancellations made less than 24 hours before the scheduled visit may be subject to a no-show fee of €35.00, in accordance with the standard practice of Orthodontist clinics in the Valencia region.
- This Quotation Estimate does not cover pre-existing dental conditions (e.g., periodontal disease, caries, or the need for extractions) that must be resolved before orthodontic treatment can commence. A separate estimate will be issued for any such preliminary work.
- All clinical data and treatment records are stored in compliance with the Spanish Organic Law 3/2018 on Personal Data Protection (LOPDGDD) and the EU General Data Protection Regulation (GDPR).
- The patient acknowledges that the treating Orthodontist, Dr. María Elena Serrano, is a registered member of the Spanish Society of Orthodontics (SEDO) and the European Orthodontic Society (EOS), and that all procedures will be performed in accordance with the clinical guidelines established by these professional bodies.
- Any disputes arising from this Quotation Estimate or the subsequent treatment will be governed by the laws of the Kingdom of Spain, with exclusive jurisdiction of the courts of Valencia, Comunitat Valenciana.
By signing below, the patient confirms that they have received, read, and understood this Quotation Estimate for Orthodontist services in Spain Valencia. The patient authorises the commencement of the treatment plan as described herein and agrees to the payment structure selected above.
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Patient Signature: Name: ______________________________ Date: ______________________________ |
Orthodontist / Clinic Representative: Dr. María Elena Serrano Date: ______________________________ |
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