Smile Protect Plan

Retainer wear is a lifetime commitment once orthodontic treatment has been completed to ensure the investment in your smile isn’t lost.

The majority of patients have to replace retainers multiple times, even within the first 5 years of completing treatment. Replacing these retainers can become costly, which is why we are offering our patients the opportunity to enroll in a lifetime retainer program. Whether you accidentally throw it away with your lunch, your dog eats it, or it just disappears, the Smile Protect Plan has you covered.

Customary fees for retainer replacement=

Clear Retainer

$400 for upper and lower
($200 per retainer)

Hawley Retainer

$500 for upper and lower
($250 per retainer)

TO AVOID THESE REPLACEMENT FEES

ENROLL IN SMILE PROTECT PLAN

Pay the one-time enrollment fee of $550

Never pay the $400 or $500 retainer replacement fee, no matter how many you have to replace!

Only pay a $45 office visit fee each time you need a retainer replacement.

CHOOSE TO OPT-IN OR OPT-OUT BELOW

Which do you choose?*
- Opt In
  Yes, I want to enroll in the Smile Protect Plan for $550 to ensure I receive retainers for life, no matter how many need to be replaced. I understand I will only need to pay the $45 office visit charge any time I need retainers replaced.
- Opt Out
  No, I do not want to enroll in the Smile Protect Plan for the special fee of $550. I understand this means that I will incur a $400/$500 customary replacement fee ($200 or $250 per upper and lower retainer) every time I need to replace a retainer.
Patient Name*
Date of Birth*
MM slash DD slash YYYY
Office*
Guardian Name*
Email
Phone
Guardian Signature*

This serves as my signature to opt in or opt out
Date*
MM slash DD slash YYYY