Retainer care acknowledgment form

Retainer care acknowledgment form

Retainers are to be worn EVERY NIGHT for as long as you want your teeth to remain perfect!

- When cleaning your retainer, simply brush them using your finger or a toothbrush and liquid soap after removal daily. Do not use toothpaste or hot water.
- When removing your retainer, do not pull from the front, as it will make it difficult to remove them.
- Place them in the protective case provided whenever they are not in your mouth.
- You will still need to see the Orthodontist occasionally for a check of stability. Bring your retainer with you every time.

Vivera

You have been provided with 3 identical copies. Wear each set for 15-18 months each. If you have lost, worn through or cracked the retainer please change to a new set. If you run out, we can order new sets for a fee.

Essix

Replacement or repair will incur a cost between $100-200. (Please keep the molds safe as we will need these to remake the retainer.)

Acknowledgement(Required)
Name
MM slash DD slash YYYY