Finances are settled in accordance with the American Association of Orthodontists’ proration formula for early discontinuation of treatment. 25% of total fee is incurred at appliance placement (treatment commencement), the first ½ of treatment is worth 50% of the total fee, and the remaining 25% is allotted to the second ½ of treatment. Refunds or charges upon transfer will solely be based on this.
Advice for the Transferring Orthodontic Patient
Printable Release Records
Please print, complete and sign the above form and fax back to us as soon as possible, so we can forward the records to your new orthodontist. Please be prepared to pay either $50 or $100 to process the transfer, depending on whether the lab work of model duplication was incurred or not.
These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.
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