Orthodontic Treatment Consent Form
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Orthodontic Treatment Consent Form
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The Orthodontic Treatment Consent Form is tailored for orthodontic practices and dental offices providing teeth straightening and bite correction services. It provides patients with a thorough understanding of their proposed treatment plan, anticipated duration, associated risks, and the responsibilities they must fulfill for successful treatment outcomes.
This template covers treatment options including traditional braces, ceramic brackets, lingual braces, and clear aligner systems. It addresses potential complications such as root resorption, decalcification, tooth sensitivity, and the possibility that treatment duration may extend beyond initial estimates. The form also emphasizes patient compliance requirements including oral hygiene protocols, dietary restrictions, appliance care, and appointment attendance.
Used by orthodontic specialists, pediatric dentists, and general dental practices offering orthodontic services, this form protects both the practice and the patient by clearly documenting expectations, risks, and the shared commitment required for successful orthodontic treatment.
What's included
- Patient and guardian identification fields
- Treatment type and duration estimates
- Risk and complication disclosure
- Patient compliance and care requirements
- Financial agreement acknowledgment
- Signature and authorization fields
- Consent agreement with e-signature
Who uses this template
- Obtaining informed consent before placing braces or starting clear aligner therapy
- Documenting patient understanding of orthodontic treatment duration and risks
- Recording guardian authorization for minor orthodontic patients
- Establishing compliance expectations for oral hygiene and appliance care
All form fields
12 fields across 2 pages. Customize any field after signing up.
How to use the Orthodontic Treatment Consent Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Orthodontic Treatment Consent Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Orthodontic Treatment Consent Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 12 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Orthodontic Treatment Consent Form HIPAA compliant?
Yes. All Formisoft templates, including the Orthodontic Treatment Consent Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Orthodontic Treatment Consent Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Orthodontic Treatment Consent Form for your practice. Set up in minutes.
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