What is a orthodontic treatment contract?
An orthodontic treatment contract is the financial and responsibilities agreement for a course of braces or aligners. It sets the total fee and how it's paid, and explains what the patient must do — attend, keep teeth clean, wear aligners and retainers — for treatment to work.
This template covers the treatment type and arches, an estimated treatment time that may run longer, what the fee includes and excludes, an initial payment and optional monthly instalments, estimated insurance benefits, missed appointments, oral hygiene, breakages and lost aligners or retainers, long-term retainer wear, early termination by either side with a fair final account, and record transfers. It is separate from the clinical informed consent. FileIt places the signature, date, job-title and initials boxes for the practice and the patient or parent.
- Best for
- Orthodontic practices and dentists providing braces or clear aligners
- Signed by
- The practice and the patient, or a parent or guardian
- Treatment
- Metal, ceramic or lingual braces, clear aligners, removable or functional appliances
- Length
- About 3 pages, initialled on every page
When to use a orthodontic treatment contract
- Fixed braces for a teenager, with a parent responsible for fees
- Clear aligner treatment for an adult
- A functional appliance followed by fixed braces
- Upper-only treatment for minor crowding
- Treatment with an insurance benefit and a monthly payment plan
What you fill in
21 blanks, then the name and email of each person who signs: practice, patient or parent.
1 The parties
- Practice*
- Treating orthodontist or dentist*
- Practice phone or email*
- Responsible person (signing)*
- Patient (if different)
- Responsible person's phone or email*
2 Treatment
- Treatment type* fixed metal braces · fixed ceramic (tooth-coloured) braces · lingual braces · clear aligners · a removable appliance · a functional appliance followed by fixed braces
- Arches treated* upper and lower · upper only · lower only
- Estimated active treatment time*
- Treatment plan summary (optional)
3 Fee and payment
- Currency*
- Total treatment fee*
- The fee includes*
- Initial payment*
- Monthly instalments (optional)
4 Insurance
- Estimated insurance benefit (optional)
- Insurance plan (optional)
5 Appointments and appliances
- Missed appointment fee (optional)
- Replacement aligner or retainer charge*
- Repeated breakage charge (optional)
6 Other terms
- Governing law*
7 Who signs
- Practice signature and date, job title, initials on every page · The orthodontic practice, signed by the orthodontist or treatment coordinator.
- Patient or parent signature and date, initials on every page · The patient, or a parent or guardian responsible for a patient under 18.
What the orthodontic treatment contract covers
- The treatment
- Fee and payment
- Insurance
- Appointments and oral hygiene
- Broken and lost appliances
- Retainers
- Early termination
- General
Using the orthodontic treatment contract, step by step
1 Enter the patient
Add the practice, the treating orthodontist, the responsible person and, for a child, the patient's name.
2 Describe the treatment
Choose the treatment type and arches, enter the estimated treatment time and a short plan summary.
3 Fee, plan and insurance
Enter the total fee and what it includes, the initial payment, any monthly instalments and an estimated insurance benefit.
4 Appliances and send
Set any missed-appointment fee and replacement charges for aligners, retainers and repeated breakages, then add the patient or parent as a signer.
Tips before you send it
- Use this contract together with your clinical informed consent; it deals with fees and responsibilities only.
- Explain that insurance estimates aren't guaranteed and the responsible person pays any shortfall.
- Make retention expectations clear at the start — teeth can move at any age without retainers.
- Healthcare record and privacy laws apply to your records; follow those that apply to your practice.
Sign it online in minutes
- Fill in the blanks. Names, dates and amounts go straight into the agreement — the preview shows exactly where.
- Name who signs. Tick “This is me” for your own part. FileIt builds the PDF with every signature, date and initials box on the right line, and you can check or move anything before sending.
- Send it. Each signer gets a secure link and signs from any device — no account needed. The signed PDF, with an audit trail and a Certificate of Completion, is filed in your vault and emailed to everyone.
Orthodontic treatment contract: frequently asked questions
What if treatment takes longer than estimated?
If it's not the patient's responsibility, no extra fee is charged for extra adjustment appointments. Significant plan changes and any fee change are agreed in writing first.
What if we move away mid-treatment?
The responsible person can stop treatment in writing. The practice calculates the fee for treatment provided so far, including appliances and records, refunds any overpayment or invoices any shortfall, and sends records to the new orthodontist on request.
Are lost aligners covered?
Breakages are repaired as part of the fee within reason, but lost or damaged aligners, removable appliances and retainers are replaced at the charge you set.
Is it valid if signed online?
In most countries, including the US (ESIGN Act and UETA), the UK, the EU (eIDAS) and Canada, an electronic signature is generally valid for an ordinary services contract like this one. FileIt keeps an audit trail and a Certificate of Completion with the signed PDF as evidence of who signed and when.
Can I change the wording?
You fill in the blanks and choose the options on the setup page; optional clauses appear only when you fill them in. If you need different clauses, draft your own document and upload it to FileIt eSignature instead — you can still place the signature boxes in the editor.
Is this template free?
Yes. The template is free to use with the eSignature app in FileIt. The person you send it to doesn't need a FileIt account to sign.