Clear Aligner Handover & Patient Confirmation

Privacy notice

The data collected is used exclusively to document your orthodontic treatment. Further information can be found in the practice's privacy policy.

I have taken note of the privacy notice.

Practice name

Clinician name

Patient ID*

Date of birth*

First name*

Last name*

Patient is a minor

Date of aligner handover*

Treatment phase or aligner number

Upper jaw aligner from

Upper jaw aligner to

Lower jaw aligner from

Lower jaw aligner to

Planned change interval*

Recommended daily wear time*

Next check-up appointment

Internal case number

Treating doctor

Practice location

Remarks