Patient forms alvarez orthodontics bethlehem center. Theyre like handles, giving aligners something to gently push on. Your doctor has recommended the invisalign system for your orthodontic treatment. Free invisalign consent form pdf authorization forms. The doctor and staff are dedicated to achieving the best possible result for each patient. Patient information for invisalign wye dental surgery. Although orthodontic treatment can lead to a healthier and more attractive smile, you should also be aware that any orthodontic treatment including orthodontic treatment with. If youre unable to open pdf files, you can get adobe. Text signup to 33017 to sign up for invisalign alerts. I understand the benefits, risks, alternatives and inconveniences associated with treatment as well as the option of no. The doctor and staff are dedicated to achieving the best. There are times, however, when we may seek personal information from you, about yourself, or about someone you know, such as a name, email address andor home address.
Informed consent and agreement for the invisalign patient 3 of 3 informed consent i have been given adequate time to read and have read the preceding informat. Sullivan is always utilizing contemporary approaches to orthodontics. Invisalign is an aesthetically pleasing alternative to braces, one which requires the patients full participation in using the invisalign aligners to their full poten. Your dentist, simon oldham, has recommended the invisalign system for your orthodontic treatment. Patients informed consent and agreement regarding invisalign orthodontic treatment. Your browser is no longer officially supported, please upgrade to a modern browser. Informed consent espanol pdf if youre unable to open pdf files, you can get adobe reader for free. The invisalign informed consent form is filled out by a patient in order to give their orthodontist authorization to use invisalign as a cosmetic treatment. Confirmation of eligibility for orthodontic services orthodontic informed.
These will be removed after treatment is completed. Please take the time to fill out these patient forms before your first appointment to ensure a speedy visit to the baltimore, md office of premiere orthondontics. I have read, understand and agree to the terms set forth in this consent as. This form is to be signed by your invisalign patients prior to treatment and kept for your records and. Aao updates informed consent form the updated aao form, informed consent for the orthodontic patient now includes a section on transferring to another orthodontist during. Any use outside of this informed consent agreement must be preapproved by me in writing. As a general rule, informed and cooperative patients can achieve positive orthodontic results.
This, in turn, has caused many orthodontists to assume a defensive attitude in their practices. This form is to be signed by your invisalign patients prior to treatment. I understand the benefits, risks, alternatives and inconveniences associated with treatment as well as the option of no treatment. I understand the benefi ts, risks, and inconveniences associated with treatment. Tips in creating invisalign informed consent forms. Patients informed consent and agreement regarding invisalign. A photostatic copy of this consent shall be considered as effective and valid as an original. Patient informed consent form clearcorrect support. I understand there is a charge for additional sets of aligners. Invisalign informed consent and agreement for the invisalign patient. This document informs the patient about the responsibilities.
Com invisalign informed consent and agreement for the invisalign patient 2 of 3 vi the aligners may temporarily affect speech and may result in a lisp, although any speech impediment caused by the invisalign products should disappear within one or two weeks. Invisalign i7 case, only one autorefinement, of up to 7 aligners is available. Invisalign informed consent and agreement for the invisalign patient 1 of 3 notice to treating office. Privacy policy the clear alternative to braces invisalign. Invisalign informed consent and agreement for the invisalign patient 3 of 3 services and does not and cannot practice medicine, dentistry or give medical advice. Informed consent and agreement for the invisalign patient notice to treating office. Sullivan to create a plan for your entire treatment before it even starts. Invisalign informed consent forms contain a lot of texts which must be read easily and be understood by the user.
Confirmation of eligibility for orthodontic services orthodontic informed consent for use of bisphosphonates or other antiresorptives. Invisalign is a treatment which uses aligners, a less visible alternative to braces in improving tooth alignment. Invisalign informed consent and agreement for the invisalign. I have read, understand and agree to the terms set forth in this consent as indicated by my signature below. I have been given adequate time to read and have read the preceding information describing orthodontic treatment with invisalign aligners. In this form, both the participant and the investigator or the researcher will have to state their names, and other pieces of information, and affix their signatures. Like other orthodontic treatments, the use of invisalign products may involve some of the risks outlined below. Invisalign patients prior to treatment and kept for your records and should not be sent to align technology, inc. For assistance, call us at 888 33323 as of january 1, 2019, the straumann group will distribute the products of clearcorrect ltd, 21 cypress blvd, suite 1010, round rock, tx 78665 to customers in germany, spain, portugal, united kingdom and switzerland. The legal doctrine of informed consent has struck a chord of fear in most dental practitioners today. Com informed consent and agreement for the invisalign patient notice to treating of. We intend to let you know before we collect such personal information from you on the internet and to get your informed consent to process such personal information where required. Bethlehem office 4000 wegmans dr, ste 100 bethlehem, pa 18017. Patients informed consent and agreement regarding invisalign orthodontic treatment dr.
The invisalign consent form is one that gives your healthcare professional the ability to apply all of invisalign s components to maximize the results of the process. By providing your cell phone number, you have provided align technology with consent to send you text message alerts, notifications. Informed consent i have been given adequate time to read and have read the preceding information describing orthodontic treatment and use of the acceledent accessory device. While recognizing the benefits of a pleasing smile and healthy teeth, you should also. This, in turn, has caused many orthodontists to assume a defensive attitude in their. Patient forms orthodontist waterville augusta me invisalign. Com invisalign informed consent and agreement for the invisalign patient 2 of 3 vi the aligners may temporarily affect speech and may result in a lisp, although any speech impediment caused by the invisalign. Clearcorrect informed consent and agreement successful orthodontic treatment is a partnership between the doctor and the patient. 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. These risks are seldom serious enough to contraindicate invisalign treatment, but should be.
This document informs the patient about the responsibilities, inconveniences, and possible risks associated with the. Informed consent and agreement for the invisalign patient 3 of 3 informed consent i have been given adequate time to read and have read the preceding information describing orthodontic treatment with invisalign aligners. Your dentist, simon oldham, has recommended the invisalign system for your orthodontic. This is the reason why the colors to be incorporated into the form should be kept minimal as well as the font styles and the images or logos to be placed in the form. In addition, i agree that align may use the information provided by my doctor for the invisalign program provided my name is not identified and my. Informed consent release form this is the type of informed consent form that students can use for their research and thesis studies. Documentmakers who will be creating invisalign informed consent forms from scratch or by using templates must keep the following tips in mind to ensure that the finalized document is efficient and effective in delivering information to the parties involved, as well as in gathering necessary data be specific. Documentmakers who will be creating invisalign informed consent forms from scratch or by using templates must keep the following. Please take a minute to print and fill out the patient information form before your first appointment. New patient forms mk orthodontics waterville augusta me sidney. Com invisalign informed consent and agreement for the invisalign patient 2 of 3 vi the aligners may temporarily. Although orthodontic treatment can lead to a healthier and more attractive smile, you should also be aware that any orthodontic treatment.
It, like any other treatment of the body, has some inherent risks and limitations. If youre a clearcorrect provider, sign in below to submit and manage your cases. This involves your doctor capturing a 3d image of your teeth and mouth for various purposes, as determined by your. Invisalign informed consent and agreement informed consent i have been given adequate time to read and have read the preceding information describing orthodontic treatment with invisalign aligners. Aao updates informed consent form the updated aao form, informed consent for the orthodontic patient now includes a section on transferring to another orthodontist during treatment.
In addition, i agree that align may use the information provided by my doctor for the invisalign program provided my name is not identified and my eyes are blocked out on photos. Invisalign straightens teeth using nearly clear retainers. Invisalign is an aesthetically pleasing alternative to braces, one which requires the patients full participation in using the invisalign aligners to their full potential. Theyre like handles, giving aligners something to gently push. I have discussed use of the invisalign andor clear correct system with dr. This form is to be signed by your invisalign patients prior to treatment and kept for your records and should not be sent to align technology, inc. The invisalign consent form is one that gives your healthcare professional the ability to apply all of invisaligns components to maximize the results of the process. Informed consent and agreement for the invisalign patient 2 of 3 viii attachments may be bonded to one or more teeth during the course of treatment to facilitate tooth movement andor appliance retention. Informed consent and agreement for the invisalign patient 30f3 informed consent i have been given adequate time to read and have read the preceding information. Smartforce attachments are small toothcolored shapes that are attached to your teeth before or during your invisalign treatment. With my signature below, i consent to treatment using the invisalign andor. Bedont has recommended the invisalign system for your orthodontic treatment. Invisalign information and consent invisalign treatment outcomes and treatment timelines are dependent on the quality of the product from align technology 2 million cases, 97% patient satisfaction, the experience of your dentist in working with invisalign, and your level of participation in this process. Like other orthodontic treatments, the use of invisalign products may involve.
Invisalign treatment remains an elective procedure. Free invisalign informed consent form pdf eforms free. I have been sufficiently informed about the invisalign andor clear correct system and have had the opportunity to ask question and discuss concerns. Medical history form adult doc medical history form under 18 doc. Informed consent and agreement for the invisalign patient. By providing your cell phone number, you have provided align technology with consent to send you text message. Invisalign consent informed consent for the invisalign patient generally, excellent invisalign results can only be achieved with informed and cooperative patients.
If consent is not given for the recommended treatment, even if not included in this initial treatment plan, the dentist. We provide this document so you can inform your patients of. If youre unable to open pdf files, you can get adobe reader for free. Were excited to launch the new doctor portal experience.
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