Braces Removal and Retainer Consent

Congratulations! Today is the day your braces are coming off to unveil your fabulous new smile! You are now entering an important phase of your treatment- The Retention Phase.


Completed orthodontic treatment does not guarantee perfectly straight teeth for the rest of your life. Teeth have a memory and often try to move back to their original positions. Retainers are required to keep your teeth in their new positions. Regular retainer wear is often necessary for lifetime as your body is continually undergoing growth and maturation. Minor irregularities, particularly in the lower front teeth, may occur. In summary, you need your retainers to keep your teeth as straight as possible, but even with good retainer wear your teeth may move slightly.

Consent for Braces Removal

I am pleased pleased with my/my child’s smile and consent to the removal of the braces/appliances (Parent/Guardian Signature)

Retainer Instructions and Responsibilities

1. Wear my retainers as instructed by Dr. Dobbs.

2. Take my retainers out while eating and ALWAYS put them in their case.

3. Maintain my scheduled retention appointments as prescribed by Dr. Dobbs.

4. Always bring my retainers to my retention appointments.

5. Clean retainers thoroughly once a day.

6. Call the office immediately if my retainer breaks or is not fitting properly.

I understand that I have the above responsibilities (Patient Signature)

Lost or Broken Retainers


Your retainers are made using only the best possible material. If a retainer is lost or damaged, call our office immediately to schedule an appointment. There will be a laboratory charge per replacement retainer. 

I understand there will be a fee to replace lost/broken retainers (Parent / Guardian Signature)



1516 Coleman Road

Ste. 208

Knoxville, TN 37909 map


TELEPHONE: 865.588.1644

FAX: 865.602.2450



M  8:00 - 12 (Staff Only)

T-Thurs  8:00 - 5:00  

F  7:30 - 3:00




American Association of Orthodontists
American Board of Orthodontics
Knoxville Invisalign
Knoxville Invisalign Teen
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1516 Coleman Road, Suite 208 Knoxville, TN 37909 TEL 865.588.1644             

© 2018 by dobbs orthodontics. All rights reserved.