Patient_______________________________________    Date__________________



You have been an Invisalign patient for a while and we respect that you have made a decision to not regularly come in for further appointments.   We understand that sometimes life events compete with our other commitments and we want to be sensitive to those other commitments you may have. At this point we need to decide whether you will continue further with your Invisalign treatment.


We would be happy to make you retainers at your current bite and alignment positions to maintain your teeth and smile where they are. This has been included in your treatment and is provided at no additional fee from our office for this first set of retainers. For this to happen, simply contact our office within the next 90 days for an appointment to receive these custom appliances. Thereafter, you would not be making regular appointments unless some concern or need arises. Any future replacement retainers and office imaging or visits would have a fee, according to what may be needed at that time.


If you choose to continue your treatment now or in the future we need to review expectations for revised fees and expected finishing dates. This would require that we see you in the clinic to establish how far we have progressed and determine what level of modification is required to get you back on track. Due to the extra hours and attention required to redirect your case back on track there is often a newly established fee schedule which we can discuss at your next visit. If you stay in retainers, then this would not apply.


We hope and trust that these explanations are helpful. If you have further questions, please ask. Let us know your decision. Thank you.




The Hi 5 Orthodontic Team

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