THPDental - Completion of Orthodontic Treatment Consent Form

Central Office

Please read the following consent and agreement for the Invisalign Go patient and fill out the form:

The Final Result

Before removing the orthodontic appliances it is important that you are satisfied with the final result. Be certain that you are satisfied before you agree to the removal of your appliances.

Retention

Teeth have a tendency to return to their original position unless a retainer is worn (Full time wear in the first year after removal, further instructions will be given by Dr. Lau after). At the end of treatment it is necessary to retain the teeth in position, otherwise they may move out of alignment.

Maintenance of Retainers

Retainers may wear or break. If not repaired or replaced, your teeth may move. Contact us immediately if your retainer becomes damaged.

Follow-up Appointments

To ensure a long lasting result it is necessary to be checked at regular intervals.

Completion Agreement

I am satisfied with the position of my teeth / my child's teeth.
I am happy to have the bands, brackets or appliance removed.
I understand the need to return as soon as possible if my retainer breaks or any teeth move out of position.
I understand the need for regular follow-up appointments.

I have been given the opportunity to ask questions about orthodontic treatment.

I have read and understood this consent form and have been given a copy to take home.

Patient's Name*

Phone Number*

Email*

Name of Patient / Parent / Legal Guardian*

Relationship with patient

Patient's Signature*