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SmileDirectClub's aligner system is a series of invisible, BPA-free plastic aligners which apply subtle pressure to gradually shift your teeth. The invisible aligners are made to be worn in a specific sequence. Each new aligner will gradually shift teeth. While every case is unique to each patient, the process typically takes approximately 4 to 8 months to complete. During treatment an optional teeth whitening system may be used. You should be aware of the benefits, inconveniences and risks related to using aligners and teeth whitening products. Please be advised that we may not be able to achieve all aspects of your chief complaint. This is due to factors beyond our control, including the guidelines and parameters we must follow with remote clear aligner therapy. However, with your chief complaint in mind, we will provide you with the best possible outcome that can be achieved, if you are a candidate for treatment with SmileDirectClub. Feel free to contact the SmileDirectClub patient care team to discuss any concerns you may have.
SmileDirectClub aligners are most effective if your teeth and gums are healthy. It is your responsibility to see a dentist within 6 months prior to starting SmileDirectClub aligners, to verify that your teeth and gums healthy prior to using SmileDirectClub aligners. It is also your responsibility to maintain and have follow-up dental care during and after SmileDirectClub aligner therapy.
My dentist cleaned my teeth. My dentist took x-rays of my teeth. My dentist checked for and repaired cavities, loose or defective fillings, crowns or bridges. My dentist checked my x-rays and I have no shortened or resorbed roots. My dentist checked my x-rays I have no impacted teeth. My dentist has probed or measured my gum pockets and says I do not have periodontal or gum disease. My dentist preformed a full oral-cancer screening in the last 6 months and I do not have oral cancer. I have no pain in any of my teeth. I have no pain in my jaws. I have no loose teeth. I have no “baby teeth” and all of my permanent teeth are present.
TELEHEALTH I hereby consent to engaging in telehealth with SmileDirectClub, as part of my aligner treatment. I understand that "telehealth" includes the practice of health or dental care delivery, diagnosis, consultation, treatment, transfer of medical/dental information, both orally and visually, to an affiliated SmileDirectClub licensed dental professional within my state.
I further consent to SmileDirectClub sharing my personal and medical information with third parties, business associates, or affiliates for the purposes of treatment planning and/or manufacturing purposes.
I certify that I can read and understand English. I acknowledge that SmileDirectClub has not made any guarantees or assurances to me. I have read this form and fully understand the benefits and risks listed in this form related to my use of SmileDirectClub aligners and whitening system. I have had an opportunity to discuss and ask any questions to a SmileDirectClub provider about the use of SmileDirectClub aligners. I understand that SmileDirectClub cannot guarantee any specific results or outcomes. I further understand that my SmileDirectClub invisible aligner treatment will only address the alignment of my teeth and will not correct my existing bite condition. In order to correct the current condition of my bite, I will need to seek more comprehensive treatment via local dental professional. Because I am choosing not to engage the in – patient services of a local dental professional, I understand and accept that my teeth will be straighter than they currently are but may still be compromised.
I hereby grant SmileDirectClub the right to use photographs taken of my dental treatment and my first name for educational and/or marketing purposes. I acknowledge that since my participation is voluntary, I will receive no financial compensation and agree that my participation is voluntary, I will receive no financial compensation and agree that my participation confers upon me no right of ownership. I release SmileDirectClub from liability for any claims by me or any third party in connection with my participation or use of the invisible aligner treatment.
In the event that SmileDirectClub ("SDC") determines that I am not an appropriate candidate for SDC treatment, but that I am a candidate for more – advanced clear aligner treatment, I hereby consent to having all of my records in SDC's possession (including without limitation dental impressions, digital scans, photographs, and medical history documentation) sent to Align Technology, Inc. for further review and treatment planning, including, but not limited to, contacting me to refer my case to an Invisalign – certified provider of my choosing or to market and sell me Invisalign products or services.
All we need to get started is a low $250 down payment with no credit check.
We will charge your debit, credit, HSA or FSA card $80 once a month for 24 months.
Feel free to call our SmileExperts anytime to process your order (800) 688-0450.
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