Invisalign informed consent and agreement for the invisalign patient. Tips in creating invisalign informed consent forms. Your dentist, simon oldham, has recommended the invisalign system for your orthodontic treatment. If youre unable to open pdf files, you can get adobe reader for free. 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.
Theyre like handles, giving aligners something to gently push. 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. Although orthodontic treatment can lead to a healthier and more attractive smile, you should also be aware that any orthodontic treatment. By providing your cell phone number, you have provided align technology with consent to send you text message. 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. Invisalign consent informed consent for the invisalign patient generally, excellent invisalign results can only be achieved with informed and cooperative patients.
Like other orthodontic treatments, the use of invisalign products may involve. Please take a minute to print and fill out the patient information form before your first appointment. Free invisalign consent form pdf authorization forms. I have been sufficiently informed about the invisalign andor clear correct system and have had the opportunity to ask question and discuss concerns. With my signature below, i consent to treatment using the invisalign andor. Patients informed consent and agreement regarding invisalign.
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. Patients informed consent and agreement regarding invisalign orthodontic treatment. Invisalign treatment remains an elective procedure. 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. Confirmation of eligibility for orthodontic services orthodontic informed consent for use of bisphosphonates or other antiresorptives. Any use outside of this informed consent agreement must be preapproved by me in writing. 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. Clearcorrect informed consent and agreement successful orthodontic treatment is a partnership between the doctor and the patient. Invisalign informed consent forms contain a lot of texts which must be read easily and be understood by the user.
The legal doctrine of informed consent has struck a chord of fear in most dental practitioners today. The doctor and staff are dedicated to achieving the best possible result for each patient. This form is to be signed by your invisalign patients prior to treatment and kept for your records and. Invisalign is an aesthetically pleasing alternative to braces, one which requires the patients full participation in using the invisalign aligners to their full potential. 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. Informed consent and agreement for the invisalign patient notice to treating office. Informed consent and agreement for the invisalign patient. Invisalign patients prior to treatment and kept for your records and should not be sent to align technology, inc. Patient informed consent form clearcorrect support.
I understand the benefits, risks, alternatives and inconveniences associated with treatment as well as the option of no. 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. Patients informed consent and agreement regarding invisalign orthodontic treatment dr. Bethlehem office 4000 wegmans dr, ste 100 bethlehem, pa 18017. 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. It, like any other treatment of the body, has some inherent risks and limitations. This document informs the patient about the responsibilities. The doctor and staff are dedicated to achieving the best. Invisalign informed consent and agreement for the invisalign patient 1 of 3 notice to treating office. 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. Confirmation of eligibility for orthodontic services orthodontic informed. Privacy policy the clear alternative to braces invisalign. 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.
Medical history form adult doc medical history form under 18 doc. Invisalign i7 case, only one autorefinement, of up to 7 aligners is available. I have discussed use of the invisalign andor clear correct system with dr. Your dentist, simon oldham, has recommended the invisalign system for your orthodontic. 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. Patient forms orthodontist waterville augusta me invisalign. This document informs the patient about the responsibilities, inconveniences, and possible risks associated with the. 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. Theyre like handles, giving aligners something to gently push on. Invisalign is an aesthetically pleasing alternative to braces, one which requires the patients full participation in using the invisalign aligners to their full poten. Bedont has recommended the invisalign system for your orthodontic treatment. Sullivan is always utilizing contemporary approaches to orthodontics.
These risks are seldom serious enough to contraindicate invisalign treatment, but should be. This form is to be signed by your invisalign patients prior to treatment. 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. Invisalign clear aligners fit smoothly and tightly around them, so theyre barely noticeable. Com invisalign informed consent and agreement for the invisalign patient 2 of 3 vi the aligners may temporarily. Your browser is no longer officially supported, please upgrade to a modern browser. 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. If youre unable to open pdf files, you can get adobe. Invisalign is a treatment which uses aligners, a less visible alternative to braces in improving tooth alignment. Your doctor has recommended the invisalign system for your orthodontic treatment.
New patient forms mk orthodontics waterville augusta me sidney. 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. This, in turn, has caused many orthodontists to assume a defensive attitude in their. 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. 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. 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. I understand the benefi ts, risks, and inconveniences associated with treatment.
I have been sufficiently informed and have had the. I understand there is a charge for additional sets of aligners. 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. Invisalign informed consent and agreement for the invisalign. Documentmakers who will be creating invisalign informed consent forms from scratch or by using templates must keep the following. 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. This, in turn, has caused many orthodontists to assume a defensive attitude in their practices. 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. If youre a clearcorrect provider, sign in below to submit and manage your cases. I have read, understand and agree to the terms set forth in this consent as. While recognizing the benefits of a pleasing smile and healthy teeth, you should also. Invisalign straightens teeth using nearly clear retainers. We provide this document so you can inform your patients of.
Smartforce attachments are small toothcolored shapes that are attached to your teeth before or during your invisalign treatment. 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. Patient forms alvarez orthodontics bethlehem center. I understand the benefits, risks, alternatives and inconveniences associated with treatment as well as the option of no treatment. 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. Informed consent release form this is the type of informed consent form that students can use for their research and thesis studies.
If consent is not given for the recommended treatment, even if not included in this initial treatment plan, the dentist. A photostatic copy of this consent shall be considered as effective and valid as an original. Com informed consent and agreement for the invisalign patient notice to treating of. 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. Text signup to 33017 to sign up for invisalign alerts. Patient information for invisalign wye dental surgery. These will be removed after treatment is completed. Informed consent espanol pdf if youre unable to open pdf files, you can get adobe reader for free.
Were excited to launch the new doctor portal experience. As a general rule, informed and cooperative patients can achieve positive orthodontic results. By providing your cell phone number, you have provided align technology with consent to send you text message alerts, notifications. This involves your doctor capturing a 3d image of your teeth and mouth for various purposes, as determined by your. 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.
I have read, understand and agree to the terms set forth in this consent as indicated by my signature below. Sullivan to create a plan for your entire treatment before it even starts. Like other orthodontic treatments, the use of invisalign products may involve some of the risks outlined below. Free invisalign informed consent form pdf eforms free.
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