Informed consent for fabrication of a BrB:
read 1-21, and send back to DrTed in an Email (email@example.com)
with your "signature" and the date.
understand that models made by another dentist are more likely to result in
a non-fitting prosthesis.
a prosthesis is ill-fitting (fits on the molds but not on the teeth I will
have two choices: 1. To ask for a refund of 50% of the amount I paid or 2.
pay 50% of the amount I paid to have the BrB remade again. In either case I
must return the non-fitting BrB.
“stone” molds are used to make the prosthesis will probably break during
manufacture of the BrB.
will let me know immediately if the molds I provide are not of sufficient
quality to make my BrB.
realize that the “stone” mold(s) I provide DrTed must be accurate and
“free of voids” (bubbles of air that are embedded in the teeth). SEE
THE NOTE YOU SHOULD GIVE THE DENTIST WHO MAKES THE MOLDS FOR YOU.
realize that when the molds are made that I must be wearing any removable
partial dentures. And I realize that a BrB made over a removable partial may
present difficulties for the fabrication of a BrB.
know that the prosthesis is somewhat fragile and subject to breakage if not
handled with care.
am aware that the appliance is only for show and must not be used while
realize that DrTed will do his best to make the brackets adhere well to the
Aligner, but just like in real life the brackets may come off.
I may send the BrB back to DrTed for a total of 3 bracket rebond
repairs, after which there will be a rebond fee of $25/bracket.
am at liberty to Krazyglue the bracket/tube on myself.
fully understand that the BrB fits over my teeth exactly as they are the day
the molds are made.
understand that any changes made to the teeth that the BrB fits may render
the BrB non-fitting. Such changes could result from new fillings, dental
restorations crowns or bridges that the dentist makes after the molds are
I should take into account any dentistry now underway or possibly that may
need to be done in the near future.
realize that payment for the BrB is
due in advance of the fabrication of the BrB.
have been notified that I can pay for the BrB by credit card (MC, Visa) or
money order. If I pay by check DrTed will wait for the check to clear before
beginning fabrication of the BrB prosthetic.
realize that the appliance will be mailed to me by first class mail unless I
specify otherwise and am willing to pay for it.
understand that DrTed is an orthodontist in practice for more than
25 years and is a certified provider of the Invisalign aligners.
am aware of his website at http://www.drted.com.
authorize DrTed to go ahead with the construction of my BrB (s).
My choice is indicated on the choice sheet.
fully realize the BrB prosthesis does not in any way move teeth.
understand that the device must be cleaned only with soap and water; it will
stain if cleaned in any of the colored mouth washes, and will melt if
Please indicate if you found me as a result of seeing the information about the
Braces R Beautiful appliance at www.bracesarebeautiful.com
Yes I found you there......No I did not find you there.