XLUR Informed Consent & Agreement

This document is provided for your use to inform your patients of the following:

• • What clear aligners are and how they work
  • Appropriate expectations in relation to treatment and results
  • Potential risks associated with clear aligner therapy
    • adverse reactions
    • potential issues (black triangles, irritation of soft tissue, IPR, tooth sensitivity, etc.)
    • potential relapse
    • additional costs
  • Establish consent to receive orthodontic treatment with clear aligners

We ask you to review this information with your patient and sign it together before starting treatment. CLICK ON THE DOCUMENT to review and download.