Orthodontic Treatment Forms

Early Treatment And Prevention
We are particularly very passionate about early intervention treatments in young children. Too often opportunities for facial and dental growth modifications are missed. With a better understanding of the causes of orthodontic problems, such as mouth breathing, poor tongue posture, and improper swallow, we can steer jaw and facial growth towards a more optimal path. As a result of early treatment, unnecessary teeth extractions and surgery may be avoidable in most cases. More importantly, negative facial and dental growth can hopefully been prevented. Also, by treating the true causes of the orthodontic problems, it would lead to a more stable result that will reduce the chances of relapse.

Emergency and Repair Policy
1. Fortunately, most orthodontic "emergencies" are not critical and there are very few true orthodontic emergencies. For your convenience and out of respect to scheduled patients, it is not typically possible to attend to repairs on a walk-ln basis.
2. If you are in significant pain for any orthodontically related reason, please call us immediately. After hours, those in pain can call either Dental Now Panorama or in case of dire emergency Dr. Gill’s cell phone number. If your appliance Is broken or a wire Is poking, please call/email to schedule an appointment to have It repaired.
3. Please keep in mind that excessive breakage of orthodontic appliances or not wearing appliances as instructed can significantly lengthen your total time in treatment. Extensive repairs may require additional appointments and longer appointments which will be scheduled on weekdays during school/work hours.
4. A reasonable amount of emergency/repair appointments are included in the Orthodontic Treatment Fee.

Benefits
Invisalign® aligners offer an esthetic alternative to conventional braces.

• Aligners are nearly invisible so many people won’t realize you are in treatment.
• Treatment plans can be visualized through the ClinCheck® software.
• Aligners allow for normal brushing and flossing tasks that are generally impaired by conventional braces.
• The wearing of aligners may improve oral hygiene habits during treatment.
• Aligners do not have the metal wires or brackets associated with conventional braces.
• Invisalign patients may notice improved periodontal (gum) health during treatment.

Informed Consent
I have been given adequate time to read and have read the preceding information describing orthodontic treatment with Invisalign aligners. I understand the benefits, risks, alternatives, and inconveniences associated with treatment as well as the option of no treatment. I have been sufficiently informed and have had the opportunity to ask questions and discuss concerns about orthodontic treatment with Invisalign® products with my doctor from whom I intend to receive treatment. I understand that I should only use the Invisalign products after consultation and prescription from an Invisalign trained doctor, and I hereby consent to orthodontic treatment with Invisalign products that have been prescribed by my doctor. Due to the fact that orthodontics is not an exact science, I acknowledge that my doctor and Align Technology, Inc. (“Align”) have not and cannot make any guarantees or assurances concerning the outcome of my treatment. I understand that Align is not a provider of medical, dental or health care services and does not and cannot practice medicine, dentistry or give medical advice. No assurances or guarantees of any kind have been made to me by my doctor or Align, its representatives, successors, assigns, and agents concerning any specific outcome of my treatment.
I authorize my doctor to release my medical records, including, but not be limited to, radiographs (x-rays), reports, charts, medical history, photographs, findings, plaster models, impressions of teeth, or intra-oral scans, prescriptions, diagnosis, medical testing, test results, billing, and other treatment records in my doctor’s possession (“Medical Records”) (i) to other licensed dentists or orthodontists and organizations employing licensed dentists and orthodontists and to Align, its representatives, employees, successors, assigns, and agents for the purposes of investigating and reviewing my medical history as it pertains to orthodontic treatment with product(s) from Align and (ii) for educational and research purposes. I understand that the use of my Medical Records may result in disclosure of my “individually identifiable health information” as defined by the Health Insurance Portability and Accountability Act (“HIPAA”). I hereby consent to the disclosure(s) as set forth above. I will not, nor shall anyone on my behalf seek legal, equitable or monetary damages or remedies for such disclosure.
I acknowledge that use of my Medical Records is without compensation and that I will not nor shall anyone on my behalf have any right of approval, claim of compensation, or seek or obtain legal, equitable or monetary damages or remedies arising out of any use such that comply with the terms of this Consent.
A photostatic copy of this Consent shall be considered as effective and valid as an original. I have read, understand and agree to the terms set forth in this Consent as indicated by my signature below.

Important Notes

• The cost of the hygiene and recall exams, as well as any other dental work such as fillings, extractions, crowns, implants are NOT included in the price of the orthodontic fees
• In particular, cosmetic treatments such as composite fillings or porcelain veneers to close spaces, restore chipped and worn teeth, and to reshape teeth are NOT included in the Orthodontic fees
• It is the policy of our practice that to receive the in-office patient discount for orthodontic treatment, the patient (and, if applicable, their family members) must pre-book their next hygiene visits before commencing treatment