Orthodontic Treatment Agreement

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I……………………………………………………. You want to perform orthodontic treatment in an ortho-occlusive dentist`s office. My treatment was discussed with me by my orthodontics and/or treatment coordinator. I read and understood the attached leaflet of the British Orthodontic Society entitled “What are the risks of orthodontic treatment?” I understand that I will receive a separate NHS jaw treatment plan. This describes the details of the parentheses and the supports I will receive, I conclude with other important facts regarding my proposed treatment. This is a Birmingham Black Country Area Team Standard Patient/Orthodontist Partnership Contract, which is awarded to all patients who perform orthodontic treatments in specialized orthopaedic practice. Patient compliance is essential if we are to achieve the best possible outcome of orthodontic treatment. This document contains useful information to ensure that the treatment is proceeding properly and that our patients get the best possible results. Once the dental appliances are mounted, I understand that I have to be part of adjustments on a regular basis — usually every 12 weeks. I was informed by my orthodontics and/or the treatment coordinator of the likely duration of my active treatment. At the end of the active treatment, the orthodontic orthodontic/orthodontic therapist therapist will remove my braces and mount supports.

The orthodontist and/or treatment coordinator will explain what the holders are and why they should be worn. The retention period begins from the day the clamps are removed. I understand that I have to make appointments on time and on the right day. If I am late, the orthodontic orthodontic orthodist may not see me, because his treatment session is late and therefore all other patients who have to participate after my appointment could be inconvenience. If I miss my appointment or cancel without notice 24 hours a day, the next appointment is offered to me (usually six – eight weeks after my late cancellation date). If this happens twice, my treatment may be discontinued prematurely in collaboration with the Local Office of England, and I will not be able to access this treatment elsewhere on the NHS. I…………………… the patient/parent/guardian of ………, by this approval to the above patient who submits to the proposed orthodontic treatment. signed:……………………………………………………. Patient/Parents/Guardians. date:…………………………………………………

I must maintain a good level of oral hygiene, keep my teeth and dental appliances clean and follow the advice of the orthodontist and his employees. If my cleaning does not reach the acceptable level, I understand that my teeth are permanently marked and that the orthodontist may suggest that my braces be removed at an early stage and that my treatment be “interrupted”. I am aware that I must avoid sticky/hard food and fizzy drinks. If my braces are broken several times, I understand that the orthodontist may be forced to stop my treatment and that I will not be able to receive this treatment elsewhere on the NHS. If you have any further questions, please contact the operation on 0121 708 2994 or email reception@orthoexclusively.co.uk If you have any complaints about your relative outside normal response hours, call 111 for emergencies, which will give you advice on what to do. Please do not emergency appointments are reserved for serious disorders related to your parenthesis, which you cannot correct yourself by making the wear of the parenthesis or remove the insulting part itself as a temporary measure.