At Smith and Heymann Orthodontics, our mission is to create beautiful smiles and
provide the best possible care. Your treatment plan was designed specifically for
you, and teeth move by continuous force. To provide a successful result, we must
maintain a consistent patient-doctor relationship, including compliance and open
communication. Maintaining regular visits is essential to successful treatment.
Unfortunately, your treatment has been interrupted. While we would like to
continue your treatment, we must advance under mutually acceptable terms.
These terms include:
- All payments (if a balance is still owed) must be made on time. If any
payment is defaulted on, treatment will be terminated. If desired,
appliances will be removed at no charge.
- All scheduled appointments must be upheld. Appointment reminders will be
sent out two days in advance giving adequate time for you to give notice of
cancellation. Therefore, if any appointment is missed or cancelled without at
least 48 hours notice, treatment will be terminated.
By signing this agreement, you are committing to resume treatment with the
understanding that, for orthodontic treatment to be successful, these terms must
be honored. With your help, we look forward to helping you achieve your
treatment goals