Patient Informed Consent Form

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 against your local legal requirements and then go over the details with your patients and sign it together. 

• The documents we provide are an example only. Please ensure content included within conforms to all local laws and regulations with your local governing body.
• Collect before beginning treatment
• Covers what clear aligners are and how they work
• Potential risks of clear aligners in relation to:
  • Adverse reactions
  • Potential dentition issues (black triangles, irritation of soft tissue, IPR, tooth sensitivity, etc.)
  • Potential relapse
  • Additional costs
• Explains what patients are agreeing to in relation to treatment and results

When you submit the case, you will need to confirm that you have obtained Patient Informed Consent for this order. You can access an example Patient Informed Consent form by clicking on the hyperlink in this section.

An example Patient Informed Consent form is also available in the Resources tab in the header of the Doctor Portal homepage.

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