Edge upload bridge: digital signature first, Edge stays the system of record.

1. Treatment overview

The patient or responsible party authorizes the orthodontic office to provide an orthodontic evaluation and the treatment plan selected by the provider. Treatment may include braces, clear aligners, appliances, retainers, imaging, progress visits, emergency checks, and related orthodontic services. Estimated treatment length is not a guarantee because patient growth, cooperation, oral hygiene, broken appliances, missed appointments, biological response, and clinical findings can change the timeline.

2. Patient cooperation and oral hygiene

• The patient agrees to follow brushing, flossing, diet, appliance, elastic, aligner, and retainer instructions.
• Broken brackets, lost aligners, missed elastic wear, or poor hygiene may extend treatment or require additional visits.
• The office may pause or modify treatment if oral hygiene or safety concerns require it.

3. Appointments, late arrivals, and no-shows

The patient or guardian is responsible for arriving on time and contacting the office in advance if a visit must be changed. Repeated missed appointments, short-notice cancellations, or late arrivals can delay treatment. The office may charge a reasonable missed-appointment or broken-appointment fee if disclosed in the final office policy and permitted by applicable law.

4. Financial responsibility

The responsible party agrees to the attached financial summary, including estimated treatment fee, down payment, payment schedule, insurance estimate, and any promotional terms. Insurance estimates are not guarantees. The responsible party remains responsible for balances not paid by insurance, missed payments, returned payments, replacement appliances, and services outside the agreed treatment scope unless the final office agreement says otherwise.

Financial summary: Estimated treatment fee, insurance estimate, down payment, monthly payment, and any promotional terms will be attached by the office before final signature.

5. Refunds, transfers, and early termination

Refunds are generally not based only on time elapsed. If treatment is discontinued early, transferred, or terminated, any refund or balance due should be calculated under the office's final written policy after accounting for records, appliances, completed services, lab costs, administrative costs, discounts, and outstanding balances. Promotional fees, retainers, records, appliances, and third-party processing fees may be non-refundable if stated in the final policy.

6. Emergencies, repairs, and replacement items

The patient should contact the office for poking wires, broken brackets, lost aligners, loose appliances, retainer issues, trauma, or urgent discomfort. Replacement retainers, lost aligners, damaged appliances, excessive repairs, or emergency visits caused by non-compliance may carry additional fees if disclosed by the office.

7. Retention after active treatment

Teeth can shift after treatment. Retainer wear is required to maintain results. The office may include an initial retainer period, but long-term replacement retainers, repair visits, or relapse treatment may involve separate fees unless the final office agreement includes them.

8. Privacy, records, and communication

The office may use phone, email, SMS, patient portal, or approved communication channels to send a contract link, appointment reminders, treatment updates, payment notices, and paperwork requests. Protected health information should only be stored in approved systems. This demo shows how Codee can route a signed packet into a private storage workflow, but production use requires the office's privacy policy, business agreements, staff permissions, audit logs, and retention rules.

9. Demo e-sign consent and Edge upload handoff

By signing this demo, the signer confirms that they reviewed the sample policy language and understands that this page is a workflow prototype. In production, Codee would let the office send a secure contract link, accept the remote or iPad signature, generate a finished PDF, save a private storage and audit copy, and give approved staff the completed PDF so they can upload it into Edge through the office's existing process.

Signature summary

Signature will appear here after the packet is generated.