APPOINTMENTS: We schedule our appointments at six-to-eight-week intervals during school and working hours. Our school-age patients will find it necessary to have some appointments during school hours. We do understand the difficulties involved in missing school classes and ask you for your cooperation in this matter. We will provide a written school excuse. If you are unable to keep an appointment, please give a 24-hour notice. If you fail to call to cancel an appointment, you will be charged a missed appointment fee of $75. Since appointments are made many weeks ahead, appointments changed at the last minute can cause delay in the goal for a beautiful smile.

GENERAL DENTISTRY: No cleanings, check-ups for cavities, fillings or extractions are included or will be performed by Dr. Mihalik. All patients are REQUIRED to maintain their regular preventive dentistry appointments with their family dentist during their orthodontic treatment. Teeth can and must be cleaned while orthodontic appliances are in place.

TREATMENT FEES: All orthodontic cases are accepted with the understanding of good patient and/or parent/guardian cooperation. Our fee includes only the procedures performed in this office. The fee is based on normal response to treatment. Included in this fee are one set of retainers. Prolonged treatment due to lack of cooperation and delay in treatment due to missed appointments will incur additional fees. If the treatment involves an appliance the patient can remove from their mouth, there will be an additional charge to repair a broken one or replace a lost one. This includes retainers.

INSURANCE ASSIGNMENTS: When our office accepts your insurance company’s assignment of benefits, it does not absolve the patient of ultimate responsibility for the full charges of the treatment rendered. The ESTIMATE provided by this office is to be considered as a guideline until the final insurance payment is received and the patient’s account has been paid in full. This office can make no guarantee of the insurance payment as estimated. Since insurance for braces is generally paid out over the time the braces are worn, if the person with the insurance leaves that job or the job changes carriers, there may be a balance remaining which the insurance company will not pay and that balance would then be your responsibility. In addition, the agreed-upon payment plan for the patient’s estimated portion must be kept current. Our administrative staff prides itself on helping our patients maximize their insurance benefits. We are always available for your questions.

TRANSFER: In the event you transfer out of our office, the amount of treatment provided up to that point will be determined; then, depending upon your individual payment plan, a refund to you or final payment to us may be required. All orthodontic records are the property of the orthodontist. However, duplicates will be sent to the next orthodontist for a fee. This office will also recommend other orthodontic specialists in other cities if you are moving away. This will help make the transition as easy as possible for the patient.

Our team is dedicated to providing exceptional patient care. To ensure that your orthodontic treatment progresses on schedule and as smoothly as possible, we would like you to understand and agree to the following:

BRUSHING & FLOSSING
• It is important that you keep your teeth clean. Our goal is that you brush three times a day and floss once a day. We have included a travel toothbrush to help encourage you to brush during the day. We have also provided floss threaders to get floss under the arch wires.

BANDS, BRACKETS, FIXED AND REMOVABLE APPLIANCES
• In the care package given after braces or appliances are placed will be a laminated card to assist you in identifying each appliance and its care. This will help all of us communicate if there is ever a question regarding your specific treatment.

FOODS
• On the same laminated card is a food list of what to avoid and others to eat with a little different technique!

ELASTICS
• During your treatment you may be required to wear rubber bands. It is very important that you wear the elastics as instructed to achieve the tooth movement desired. Not wearing your elastics can prolong your orthodontic treatment.

S.O.S. EMERGENCIES
• The good news is there are very few! But, in the unlikely event you experience pain, bleeding or swelling, please telephone our office right away. You will be seen promptly and appropriate care given or referred to another specialist for treatment. This type of emergency is usually a result of trauma to the head, face or jaw. If outside office hours, the answering message gives you the pager number.

REPAIRS
• Please notify us if you experience any loose brackets or bands, arch wires or ties, lost or broken appliances or retainers even if your next appointment is coming up soon. We may need to add more time to your upcoming appointment to make the necessary repairs or choose a different appointment time. After the third broken bracket due to patient negligence, a fee of $75 will be incurred to repair the bracket. The patient and family will be notified before charge is incurred.

APPOINTMENTS
• Our goal is to create a fun, positive welcoming environment that you enjoy visiting. We encourage you to maintain the doctor’s treatment schedule by avoiding changing appointments or missing appointments whenever possible. For your convenience, we can email and text appointment reminders. This will help keep your orthodontic treatment progressing as planned.

REFER YOUR FRIENDS AND FAMILY
• We appreciate that you have chosen us for your orthodontic care and hope your experience with us will make you want to share our name with your friends and family – that is the greatest compliment we can receive!