Dental treatment plans patients can read, choose and sign

{"ref":"WD-T-2241","practice":"Harbourside","dentist":"Dr Hamza Qureshi","date":"Prepared Thu 22 Oct 2026","valid":"Valid until Thu 26 Nov 2026","signed":"Thu 22 Oct, 4:18 pm","gateway":"Stripe","deposit_percent":20,"patient":{"name":"Tess Halloran","first":"Tess","email":"tess.halloran@example.com"},"minor":{"name":"Noah Halloran","first":"Noah","age":15,"guardian":"Tess Halloran","relation":"Parent or guardian"},"base":{"name":"Exam, X-rays & clean","lines":[{"no":"WD-EX1","item":"Comprehensive oral examination","fee":95},{"no":"WD-XR2","item":"Panoramic X-ray","fee":125},{"no":"WD-CL1","item":"Scale & clean","fee":180}]},"tools":[{"id":"fill","label":"Filling","stage":"restore","no":"WD-FL2","item":"Tooth-coloured filling","fee":245,"note":"Two surfaces"},{"id":"rct","label":"Root canal","stage":"restore","no":"WD-RC1","item":"Root canal treatment","fee":1380,"note":"Two visits"},{"id":"crown","label":"Crown","stage":"crown"},{"id":"replace","label":"Missing tooth","stage":"replace"},{"id":"extract","label":"Removal","stage":"restore","no":"WD-EXT","item":"Removal of a tooth","fee":290,"note":"Simple removal"}],"stages":{"restore":{"name":"Fillings, root canals & removals"},"crown":{"name":"Crowns","choose":"Choose the crown material","pick":"zir","options":[{"id":"pfm","name":"Porcelain fused to metal","no":"WD-CR1","fee":1650,"note":"Metal base, porcelain outer layer"},{"id":"zir","name":"Zirconia","no":"WD-CR2","fee":1950,"note":"Solid tooth-coloured ceramic"},{"id":"cer","name":"Layered ceramic","no":"WD-CR3","fee":2080,"note":"Ceramic layered by hand"}]},"replace":{"name":"Replacing missing teeth","choose":"Choose how to replace it","pick":"imp","options":[{"id":"imp","name":"Implant & crown","no":"WD-IM1","fee":5450,"per":"tooth","note":"About 4 months, 4 visits"},{"id":"bri","name":"Three-unit bridge","no":"WD-BR3","fee":4350,"per":"tooth","note":"About 3 weeks, 2 visits"},{"id":"den","name":"Partial denture","no":"WD-PD1","fee":1480,"per":"arch","note":"About 5 weeks, 3 visits"}]}},"discussed_note":"Discussed at your consultation","defaults":{"15":"fill","45":"fill","26":"crown","36":"replace"},"extras":[{"id":"guard","no":"WD-NG1","item":"Night guard","fee":520,"note":"Made to fit, with a case"},{"id":"white","no":"WD-WH2","item":"Take-home whitening trays","fee":420,"note":"Upper and lower"}],"extras_default":[],"consent":["My dentist explained this plan, the options in it and the other choices I have, and answered my questions.","I understand these are estimated fees. If the plan changes, the practice sends me a revised plan to sign.","I understand no insurance benefit is included or calculated here, and I can ask my insurer what it covers.","I understand this plan is valid until Thu 26 Nov 2026."],"fund":"Your insurer decides what it pays back. Ask your insurer what it covers for this treatment: no insurance benefit is included or calculated here.","not_included":["Specialist referrals","Hospital or anaesthetist fees","Treatment not listed in this plan"]}

1. 1Chart the teeth
2. 2The patient chooses
3. 3Consent & sign
4. 4Deposit paid

A demo with a fictional practice: nothing is sent, stored or charged. In QuoteCloud your team builds the plan from your treatment plan template: stages are price-table sections, fees and treatment codes come from your own fee list, alternatives are single-choice groups and extras are optional rows. The acknowledgements are Forms block fields with locked wording (Business). The deposit is a percentage or a fixed amount paid through Stripe or PayPal when the plan is signed (Essentials and up). Treatment codes are your practice's own; QuoteCloud does not connect to any fee schedule. It doesn't chart teeth by itself, calculate insurance benefits, book appointments or run payment plans.

How estimates and consent work