Informed Consent Form

American Academy of Gnathologic Orthopedics Journal, December 2006 | Go to article overview

Informed Consent Form


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General Information and Office Policies for Orthodontic Patients

Orthodontics is like a ball game--in order to be successful everyone involved must do his or her share. The dentist. the patient, the family doctor, the parents (if the patient is a minor), relatives and friends, all have a part in this game--all are members of the team. The score at the end of the game will depend on how well they cooperation and work together. It is important. therefore, that everyone understands the rules of the game--cooperation is the key to success.

Regular appointments for adjustments are necessary. If an appointment is missed please call for another one immediately. Charges may be made for failed appointments, or when 48 hours notice has not been given. Continue to wear the appliance as a retainer to hold the changes that have been made. Do not remove the appliances without the doctor's permission. It is the responsibility of both the patient (and the parents) to remember the time and dates of scheduled appointments. and to make a new appointment for any that have been missed. After school appointments are not always available, and students must expect to miss some time from school.

We schedule our appointments so we can stay on time: however a number of problems can put us behind schedule. Traumatic or other types of emergencies do occur and we do not turn true emergencies away. Therefore, you may want to call ahead to check if we are on schedule, or drop your child off and do some errands.

Be sure to keep regular appointments for your hygiene, examination and disease prevention program. During the adjustment of the appliances. There is not sufficient time to note defects in the teeth. Therefore the hygiene and periodic examination appointments remain an important service and must not be neglected. The patient (and parents) assume the responsibility for practicing excellent daily hygiene procedures to prevent decay. decalcification and/or gingival (gum) problems.

Habits such as sucking of fingers or thumb. biting of lips. tongue or cheek. leaning chin on hand and various sleeping habits may interfere with treatment. Outside professional help may be necessary for correction of tongue thrust. The cost of this therapy is not included in our fee.

Treatment consists of slight but very exacting adjustment of delicate wires and springs. Patients can follow their regular diet. …

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