I, the undersigned, confirm my satisfaction with the final result of my orthodontic treatment with
Invisible Aligners / fixed braces at Dr. Alaa Dental Beauty Clinic. I understand that wearing
fixed/ removable retainer is essential to maintain my newly aligned teeth. I acknowledge the
importance of following the clinic’s recommendation to wear retainers as prescribed.
I understand that choosing not to wear the retainers as directed or following the maintenance
instruction for fixed retainer may lead to a relapse or changes in my teeth alignment, for which I
will bear full responsibility. Additionally, I agree to assume any financial responsibility for
future corrections that may be needed if I do not comply with retainer use.
Furthermore, I acknowledge that if the removable or fixed retainer is lost or broken, I will be
responsible for any additional fees incurred for repair or replacement.
By signing below, I accept these terms and confirm my understanding and agreement to comply
with the above responsibilities.