Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the contract, ensuring you have access to the necessary document.
2. Begin by entering the date and your office location in the designated fields. This provides vital context for your agreement.
3. Fill in the patient's name, ensuring correct spelling, as this is a legal document.
4. Enter the Medicaid Insurance information if applicable, along with the approval number and the amount approved to secure processing.
5. Review the conditions outlined in sections 1 through 9 carefully, as they detail the obligations and responsibilities of both parties. Check each box next to the conditions as you acknowledge them.
6. Indicate the monthly payment amount you agree to pay if ineligible for Medicaid coverage, as well as the fee for additional treatment if necessary.
7. Complete the signature section at the end of the document. These signatures must clearly include the name of the parent or the patient if over 18 years old, as well as the witness or staff signature and the doctor’s signature.
8. Once all fields are completed, review the document for accuracy. If all information is correct, you may save changes, download, print, or share the completed form as necessary.

Complete your orthodontic contract form online today to ensure timely and effective treatment.