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Macquarie Fields Dental Care

1/71 Saywell Road, Macquarie Fields NSW 2564
(02) 9829-4414 · [email protected]
DEBOND CONSENT FORM

Please Read Carefully

I understand that I have completed the active part of my orthodontic treatment and now will be receiving a set of retainers, which begins the last part of my orthodontic treatment.

I realise that wearing the retainers fulltime is very important because they help to hold my teeth in their new positions.

I am satisfied with the present positions of my teeth and bite and agree with the dentist that my braces are ready to be removed.

I agree to wear my retainers as instructed and maintain regular scheduled retainer check appointments and understand that if I do not do so there could be relapse of my teeth which would require new retainers or more active treatment (at an additional cost).

If I lose or break my retainers, I know that I should call the office immediately.

Patient Details

Declaration

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