• 3 repairs to a fixed appliance • 2 repairs to an active removable appliance • Appliances broken beyond repair or lost may be replaced at a charge of £92.00 per appliance. (The charge is valid until 31st March 2024)

Feelgood Orthdontics | 77 Belmont Road | Uxbridge | UB8 1QU | 01895 233 183 | info@feelgoodorthodontics.co.uk

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This is your Personalised NHS Patient/Orthodontist Partnership Contract, which will need to be signed for your treatment to commence. Should you have any questions please don't hesitate to contact us. We look forward to working with you on achieving your new smile. Patient compliance is vital to enable us to achieve the best possible orthodontic treatment outcome. The Patient’s Commitment I wish to undertake orthodontic treatment at Feelgood Orthodontics Practice. My treatment has been discussed with me by my clinician. I have read and understood the British Orthodontic Society leaflet entitled “What are the risks of Orthodontic Treatment?” accessible at www.feelgoodorthodontics.co.uk I understand that I will be given a separate written NHS orthodontic treatment plan outlining details of the braces and retainers that I will be given. Active Orthodontic Treatment Once the braces have been fitted I understand that I will need to attend on a regular basis for adjustments – normally every 8-12 weeks. I have been informed how long my active treatment is likely to take. I will need to maintain a good standard of oral hygiene, keeping my teeth and braces clean and follow the advice of the Orthodontist and his staff. If my cleaning does not reach the acceptable standard, I understand that my teeth might be permanently marked and that the Orthodontist may suggest that my braces removed early and my treatment “discontinued”. I am aware that I have to avoid sticky/hard food and fizzy drinks. If my fixed braces are broken repeatedly, I understand that the Orthodontist may be forced to terminate my treatment and that I will not be able to access this treatment elsewhere on the NHS. I understand that I will need to attend the appointments on time and on the correct day. If I am late, the clinician may be unable to see me since their treatment session might subsequently run. If I miss my appointment or cancel without giving 24 hours’ notice, I will be offered the next available appointment (usually 6-8 weeks after the date of my failed / late cancelled appointment). Should this happen on two occasions, - in conjunction with the Local Office of England – my treatment may be terminated prematurely and I will not be able to access this treatment elsewhere on the NHS. The Retention Period and Retainers At the end of active treatment the Orthodontic Therapist will remove my braces and fit retainers explaining why they must be worn. I understand that, if retainers are removable, they need to be worn in accordance with the instructions given to me. I understand that, once the braces are removed, the responsibility for the future position of my teeth depends on my wearing the retainer’s long term. I understand that the Practice will supervise retention for a period of one year ONLY and that I will be discharged back to my dentist. Following this year period, replacement retainers will be charged for on a private basis (£125) regardless of age or exemption status. Fixed retainers (behind the teeth) are available at an additional charge of £250 per arch. I understand that, if removable or fixed retainers are broken or lost during the initial one-year period, there will be a charge. If a fixed retainer is used, it usually remains in position for at least 5 years. If I return after being discharged to have this repaired or removed, there will be a charge. I understand that, at the end of this initial year of retention, my treatment at Feelgood Orthodontics will be officially complete. There will be a charge for any further appointments, the repair or replacement of removable retainers and the repair or replacement of bonded retainers. I understand that teeth may try to move throughout life due to continued growth development or other biological changes and that I am strongly recommended to continue with part time wear of the retainers on a permanent basis (i.e. for life). My Orthodontist cannot be responsible for any movement of my teeth if I chose to stop wearing the retainers. If I contact the Practice, subsequent to ceasing the wear of my retainers with a problem that my teeth are moving out of alignment, I realise that any further treatment may involve the use of fixed appliances. There will be a charge for a review appointment (to access the problem), and for any subsequent treatment. Such subsequent treatment will not be available on the NHS. The Orthodontist will explain the treatment as fully as possible and make sure you understand the treatment options, you will also be given a written treatment plan. The outlines details of the braces and retainers that will be used, in addition to other important facts about the proposed treatment. The Orthodontist/Orthodontic Therapist will endeavour to see you on time for each appointment. If a clinic is running late, this is probably due to circumstances beyond the control of the Orthodontist. For an emergency appointment, the orthodontist may remove any discomfort only and a full repair may have to wait until your normal booked appointment. For a single course of treatment, we can only provide a maximum of Excessive number of breakages means that treatment will be ineffective and prolonged, and the orthodontist may be forced to terminate it prematurely. Please note that an administrative charge might be applied for overdue balances and referrals made to a debt collection agency. Out of Hours Emergencies If you have any discomfort in relation to your brace outside normal surgery hours please ring '111 for emergencies' which will give you advice on what to do. Please note emergency appointments are reserved for severe discomfort related to your brace which you cannot rectify yourself by ceasing the wear of the brace or removing the offending part yourself as a temporary measure.