Stimulation Video / Treatment Plan Acceptance Stimulation Video Treatment Plan AcceptancePatient Name *Date *Dentist/Orthodontist NameDr. Mohamad IssaVersion approvedI, the undersigned, confirm that: I have viewed the visual simulation/video explaining the use of clear correct aligners The video demonstrated: The expected movement of teeth over time How treatment progresses with each new set of aligners I understand the purpose of the simulation is to visually inform me about my aligner treatment journey. I had the opportunity to ask questions and receive clarification regarding my treatment. By signing below, I confirm that I understand the aligner treatment process and voluntarily accept to proceed based on the explanation provided in the video.Signee Role: (Please check one) *PatientParent / Guardian (if minor)Signee Name *Signature *Sign hereYour browser does not support e-Signature field.Submit
