Quotation Estimate Orthodontist in United Arab Emirates Dubai –Free Word Template Download with AI
United Arab Emirates • Dubai • DHA Licensed Dental Practice
Ref: QTE-2025-04871Practice Details
Dr. Sarah Al Mansoori, BDS, MSc Orthodontics
Al Marasi Dental & Orthodontic Centre
Level 4, Marina Plaza, Dubai Marina
United Arab Emirates, Dubai, P.O. Box 128456
Tel: +971 4 555 0192 | Email: [email protected]
DHA License No: DHA-ORTH-2019-44782
Patient / Client Details
Name: Mr. James R. Whitfield
Emirates ID: 784-1990-0452-1-0012-345-67
Address: Apt 12B, Palm Jumeirah, Dubai
United Arab Emirates
Phone: +971 50 774 2218
Date of Quotation: 14 June 2025
Valid Until: 14 July 2025
Following a comprehensive clinical examination conducted at our Dubai clinic on 10 June 2025, the undersigned Orthodontist has assessed the patient's dental and occlusal condition. The diagnosis indicates a Class II malocclusion with moderate crowding in the upper arch, a 4 mm overjet, and mild rotation of the upper lateral incisors. The patient has expressed interest in a full orthodontic correction plan. This Quotation Estimate outlines all anticipated procedures, associated costs in United Arab Emirates Dirhams (AED), and the projected treatment timeline as determined by the treating Orthodontist in Dubai.
| # | Description of Service | Frequency / Duration | Unit Cost (AED) | Total (AED) |
|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation & Digital Records (X-rays, CBCT, intraoral scan, photographs) | One-time | 1,200.00 | 1,200.00 |
| 2 | Orthodontic Treatment Plan & Digital Simulation (3D treatment preview) | One-time | 850.00 | 850.00 |
| 3 | Placement of Self-Ligating Ceramic Braces (Upper & Lower Arch) | One-time | 18,500.00 | 18,500.00 |
| 4 | Monthly Orthodontic Adjustment Visits (wire changes, elastic changes, progress monitoring) | 18 months | 450.00 | 8,100.00 |
| 5 | Interproximal Reduction (IPR) & Minor Tooth Contouring | As required | 1,500.00 | 1,500.00 |
| 6 | Removable Retainer (Hawley type, Upper & Lower) – post-treatment | One-time | 1,800.00 | 1,800.00 |
| 7 | Annual Retainer Review & Adjustment (Year 1 & Year 2) | 2 visits | 350.00 | 700.00 |
| 8 | Emergency / Breakage Repair (bracket re-cementation, wire adjustment) | Up to 3 visits | 250.00 | 750.00 |
| 9 | Final Debonding, Polishing & Post-Orthodontic Assessment | One-time | 1,200.00 | 1,200.00 |
| TOTAL QUOTATION ESTIMATE (AED) | 36,600.00 | |||
| VAT (5% – United Arab Emirates Federal Tax Authority) | 1,830.00 | |||
| GRAND TOTAL (AED, VAT Inclusive) | 38,430.00 | |||
- Payment Schedule: A 30% deposit (AED 11,529.00) is due upon acceptance of this Quotation Estimate. The remaining balance shall be payable in three equal monthly instalments of AED 8,967.00 spread across the active orthodontic treatment period.
- Currency: All amounts are quoted in United Arab Emirates Dirhams (AED). No foreign currency conversion fees apply for payments made within Dubai.
- Payment Methods: Cash, bank transfer, credit/debit card (Visa, Mastercard, Amex), and UAE Pass digital wallet are accepted at the Dubai Marina clinic.
- Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue. Prices are subject to revision in accordance with Dubai Health Authority (DHA) fee schedules.
- Treatment Duration: The projected orthodontic treatment timeline is 18 to 24 months, as determined by the treating Orthodontist. Actual duration may vary based on individual biological response.
- Cancellations: Should the patient discontinue treatment prior to completion, the deposit and all fees for services already rendered shall be non-refundable. A written notice of 14 days is required for any cancellation.
- Warranty: The Orthodontist guarantees the integrity of all bonded appliances for 12 months from the date of placement, excluding damage caused by patient negligence or trauma.
- Compliance: All orthodontic procedures are performed in full compliance with the regulations of the Dubai Health Authority (DHA) and the United Arab Emirates Federal Law No. 3 of 2023 on the Regulation of Health Professions.
- Confidentiality: Patient records, digital scans, and treatment images are stored in accordance with UAE Federal Decree-Law No. 45 of 2021 on the Protection of Personal Data.
By signing below, the patient acknowledges receipt of this Quotation Estimate for orthodontic treatment, confirms understanding of the proposed plan by the Orthodontist, and authorises the commencement of treatment at the Dubai Marina clinic in the United Arab Emirates. The patient confirms that all medical history, allergies, and pre-existing conditions have been disclosed to the treating Orthodontist.
Patient Signature & Date Dr. Sarah Al Mansoori – Orthodontist (DHA Licensed) ⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
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