Invisalign Consent Form

Should you decide to not attend the surgery every four weeks and insert the new aligners yourself you MUST inform us if they do not fit properly. If you have any queries regarding this, please call the surgery.*
Aligners MUST be worn at all times. Under no circumstances should you take them out for over 90 minutes at any one time.*
Do not drink extremely hot drinks or wash them in hot water as it may warp the aligners.*
Should you lose your aligner i.e. No. 10 then wear the previous aligner, No. 9 until the new aligner is ordered for you. Replacement aligners will be an extra £75 each.*
If you take it upon yourself to stop treatment for a period that is longer then recommended by your dentist a charge of £300 may occur as new impressions may need to be taken.*
If you do not attend a scheduled appointment or cancel without 24 hours notice a fee of £50 will apply.*
You have 180 days from the end of the treatment to inform us if there is any issue with movement otherwise a fee will incur as this is Invisalign’s cut off point.*
Photos of my mouth (only) may be used on our website and social media pages. I understand my face will not be used unless Vogue Dental Care contact me and I consent.*
I am aware that I could use fixed braces (sometimes called “train tracks”) to straighten my teeth and have been given the opportunity of being referred to an orthodontist for this*

INTERPROXIMAL REDUCTION

  • An important part of orthodontic treatment is creating space for the teeth to move.
  • This is done primarily by the extraction of one or more teeth or by filing away small amounts of enamel in between teeth.
  • This is called Interproximal Reduction (IPR).
  • Here is a photo of what IPR looks like
I understand what Interproximal Reduction (IPR) is*
I am happy to have Interproximal Reduction (IPR) completed on my teeth if needed during Invisalign treatment*

ATTACHMENTS

  • Attachments are placed on the surface of certain teeth to aid movement
  • They can be on any of your teeth including front teeth.
  • These are tooth coloured and removed from your teeth at the end of your treatment.
  • They will stay on the teeth at all times when you are in treatment.
I understand that I will have attachments placed on my teeth during Invisalign treatment*
I understand I may have attachments on my front teeth*
As a patient, I happily give my consent for my dental photographs consisting of my smile and my teeth alone to be used on our website.*
I understand no face shots will be used without my prior permission.*
Consent*

TREATMENT COST

Your Quoted Price includes the following:

  • All of your Invisalign appointments
  • Take-home whitening at the end of your treatment
  • 1 set of removable plastic retainers and fixed retainers at the end of your treatment
  • Before & After Photographs

*Note by having your scan taken and sent off to Invisalign you agree to a minimum charge of £150, if for any reason, you decide to cancel your treatment.

Your Quoted Price DOES NOT include the following:

  • Hygiene Appointments
  • Any General Dentistry for e.g. Fillings, Extractions, Root Canal etc.

I have been given enough time to fully understand all issues surrounding my treatment and all options have been explained to me

By signing this form, you agree to the above terms.

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