INVISALIGN INFORMED CONSENT AND AGREEMENT FOR THE INVISALIGN PATIENT

View Consent Document and Agreement
If signatory is under 21, the parent of legal Guardian must also sign to signify agreement.
Print Name
Signature
Print Name
Witness
Address

Street Address

Street Address Line 2

CityState

Zip Code
Signature of Parent/Guardian:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: