Patient Informed Consent Form

 

Click here to view and download the Patient Informed Consent Form for your area.

Patient Informed Consent Form - Spanish form for the US

Patient Informed Consent Form - French form for Canada

We provide this document so you can inform your patients of potential risks associated with clear aligner therapy, and set their expectations appropriately. The final section is a legal agreement between you and your patient, establishing that your patient consents to receive treatment and understands the risks involved. We encourage you to review the information on this form with your patients and sign it together. Though we don't require a copy of this form for our records, we strongly recommend that you keep it with your patient's records for future reference.

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ClearCorrect is a medical device manufacturer and does not practice dentistry. The treating physician is solely responsible for prescribing and administering orthodontic treatment. Clear aligner therapy is unpredictable. ClearCorrect does not guarantee a successful treatment outcome. Individual results will vary.

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