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Orthodontic Treatment Contract Form PDF File ID :110210869 File Size :19.8 MB Upload On :20161230 GENERAL ORTHODONTIC INSURANCE CODES Great LAB FM 35 Rev: 12/20/07-Page 1 Of 4 GENERAL ORTHODONTIC
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How to fill out orthodontic treatment contract form

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How to fill out orthodontic treatment contract form

01
Obtain the orthodontic treatment contract form from your orthodontist or dental office.
02
Read the form carefully to understand all the terms and conditions.
03
Start by filling out your personal information, including your name, address, phone number, and email.
04
Provide your insurance details, if applicable, including the insurance company name and policy number.
05
Next, fill out the treatment details section, including the specific orthodontic treatment being performed.
06
Specify the duration of the treatment and any additional notes or instructions.
07
If there are any financial terms, such as down payment or installment plans, fill them out accurately.
08
Carefully review the completed form for any errors or missing information.
09
Sign and date the form at the designated spaces.
10
If required, have a parent or guardian also sign the form.
11
Make a copy of the filled-out form for your records.
12
Submit the completed form to your orthodontist or dental office.
13
Keep a copy of the signed form for future reference.

Who needs orthodontic treatment contract form?

01
Anyone undergoing orthodontic treatment, such as braces or aligners, needs an orthodontic treatment contract form.
02
Orthodontic treatment contract forms are necessary for both adults and children receiving orthodontic care.
03
Patients who seek orthodontic treatment from a licensed orthodontist or dental professional require a contract form.
04
The form ensures that both the patient and the orthodontist are aware of the treatment plan, associated costs, and agreed-upon terms.
05
Insurance companies may also require an orthodontic treatment contract form for coverage purposes.
06
Parents or guardians of minors receiving orthodontic treatment may need to sign the contract form as well.
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Orthodontic treatment contract form is a document that outlines the terms of agreement between a patient and an orthodontist for orthodontic treatment.
The patient who is receiving orthodontic treatment is required to file the orthodontic treatment contract form.
To fill out the orthodontic treatment contract form, the patient must provide personal information, treatment details, payment terms, and sign the agreement.
The purpose of the orthodontic treatment contract form is to ensure both the patient and orthodontist are on the same page regarding treatment, payment, and responsibilities.
The orthodontic treatment contract form must include patient's personal information, treatment plan, payment schedule, terms of agreement, and signatures of both parties.
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