Confidential Patient Information

Congratulations! You have completed your orthodontic treatment! Together we have worked hard to give you a smile that is your signature and is attractive to everyone you meet. Now it’s time to show it off!

The next step of RETENTION- keeping your smile attractive and beautiful- is THE MOST IMPORTANT of all.

We offer several options to make it easier for you. Here are some things to think about:
  • Retention is for life – teeth like to go back to their original position.
  • The best retainer is the retainer you will actually wear!
  • After we remove your braces or aligners, we require you to wear your retainers day AND night for six (6) months. After 6 months, retainers are to be worn every night for 1 year, then a couple nights a week for life.
  • One set of retainers (One Upper and One Lower) is included with your treatment.
If you lose your retainer or the retainer breaks, the next one is on you. There are no warranties on retainers, nor does insurance cover the cost of replacing them. Replacement retainers are $275 EACH, or $550 for another set of upper and lower. For the clear tray retainers, we offer a Guardian Program to get extra sets made in advance. For a charge of $500, you will receive THREE additional SETS of clear tray retainers if you choose this before your removal. Dr Albert strongly recommends taking advantage of this program. If something happens to your first set of retainers, you will already have another one ready to go at a lesser cost than 1 replacement set. Plus, retainers are for life!

Please put an X next to ONE Upper and ONE Lower retainer you will wear, OR select which multiple set Guardian option you would like.

 If you are under 18 years of age, have your parent sign below.
Clear Plastic Tray (1 Each)
Standard Acrylic with Metal Wire
Bonded Metal Wire
Guardian retainers - multiple set options
 
First Name:
Middle Initial:
Last Name:
Patient/Parent Signature:
Date: