File: I consent to the collection of data, the taking of photographs, video capture, x-rays and necessary impressions before, during and at the end of the treatment, according to the directives of the Order of Dentists of Quebec.
Consent to Use of Record: I give my permission to use my orthodontic record for purposes of consultation, education, research and publication in professional journals.
I acknowledge having read and understood the document entitled Instructions for orthodontic treatment which outlines the potential risks associated with orthodontic treatment. I have asked all the necessary questions in order to clarify all the areas on which I had questions and I am satisfied with the answers provided.
I authorize my dentist to proceed with the orthodontic treatment knowing that she is a dental surgeon practicing orthodontics in all of her general practice since September 1992.
I agree to follow the guidelines and consent to orthodontic treatment.
I understand that the fees for orthodontic treatment only cover orthodontics. Any other treatment is not included in the fees for my orthodontic treatment.