I hereby consent to making of diagnostic records, including x-rays, before, during and following orthodontic treatment, and to the above/below doctor(s) and, where appropriate, staff providing orthodontic treatment prescribed by the above doctor(s) for the above/below individual. I fully understand all of the risks associated with the treatment.
I understand that diagnosis records (x-rays, photographs, plaster models and digital scans) are vital part of the patient record, and that they will remain in the possession of the doctor requesting their fabrication. Upon written consent, copies may be obtained for a nominal fee.