Orthodontic Contract Template – US

Disclaimer

The information provided is intended solely as a general example related to contractual arrangements for orthodontic treatment in the United States. It does not constitute legal advice and should not be relied upon as a substitute for consulting a qualified attorney specializing in healthcare agreements or consumer law. Laws and regulations may vary depending on the jurisdiction, and adjustments may be necessary to ensure compliance with local requirements. Use of this example is the user’s sole responsibility, and no liability is assumed for any errors, omissions, or consequences arising from its use without professional review.

Please note: This is a sample orthodontic treatment agreement template, provided for illustrative purposes only. Exact terms may vary based on specific treatment plans and applicable regulations.

Orthodontic Contract US Sample

Parties Involved:

Orthodontist: Smile Bright Orthodontics
Address: 123 Dental Drive, New York, NY 10001

Patient: Jane Doe
Address: 456 Elm Street, New York, NY 10002

Treatment Description:

The orthodontic treatment involves the placement of braces or aligners on the patient’s teeth to correct malocclusion and improve dental aesthetics at the address specified above, or other designated treatment sites as agreed upon.

Payment Terms:

The total fee for the orthodontic treatment shall be $5,000, payable in installments as outlined in the payment schedule. Full payment is due prior to the commencement of treatment, unless otherwise negotiated.

Orthodontist Responsibilities:

The orthodontist agrees to perform all necessary procedures according to the standard of care, provide regular follow-up appointments, and monitor treatment progress as scheduled.

Governing Law:

This agreement shall be governed by the laws of the State of New York. Disputes will be resolved within the jurisdiction of New York courts.

Additional Provisions:

• The patient agrees to attend all scheduled appointments and follow the orthodontist’s instructions.
• This contract may only be amended in writing signed by both parties.
• Treatment success depends on patient compliance with care instructions.

New York, ______________________