Patient Contract
Care That Goes Beyond
Your Treatment Fees and Payment Plan
This agreement sets out the terms of your orthodontic treatment at Beyond Braces. It lists your total treatment fee, estimated insurance coverage, initial payment and monthly payment plan, and what happens if treatment ends early.
Before You Start
- Read each section, including the payment terms, before you sign.
- If the patient is under 18, a parent or guardian signs.
- Ask us about any term you would like explained before signing.
Questions about this form? Call or text our South Surrey office at (604) 502-5155.