Embarking on the journey of orthodontic treatment involves not just a commitment to a healthier smile, but also an understanding of the financial and logistical aspects tied to the process. Great Whites Pediatric Dentistry & Orthodontics, with a team comprising Dawn Sosnick, D.D.S., Regina Hendricks, D.D.S., and Marika Chikvashvili, D.D.S., located in Huntington, NY, provides a comprehensive contract for orthodontic treatment that highlights these critical elements. This contract outlines everything from the total cost of treatment, insurance benefits, and the due dates for initial and monthly fees. Importantly, the contract clarifies that the initial fee is due upon the placement of appliances, with monthly fees expected by the 10th of each month, emphasizing the office policy that there must be no outstanding balance before the removal of appliances. The contract thoughtfully explains what the fees cover, including the active tooth movement phase typically spanning twelve to twenty-four months, plus twelve months of retention and observations. Additionally, it sets the stage for extra costs that may arise, such as for clear braces, replacement of broken appliances, missed appointments without proper notice, and unforeseen growth complications that could extend treatment time. Crucially, it puts the onus on the patient or responsible party to cover treatment fees, with insurance recognized only as partial payment, and any discrepancies or cancellations during treatment potentially leading to additional out-of-pocket expenses. This contract is not just a formal agreement but a roadmap for navigating the orthodontic treatment process with transparency and preparedness.
| Question | Answer |
|---|---|
| Form Name | Great Whites Orthodontics Contract Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | orthodontic financial agreement, orthodontic contract, ortho contract template, orthodontic treatment plan template |