Early Termination of Treatment
Address Line 2:
City: State: Zip Code:
This letter is to certify patient/patient’s parent/patient’s guardian request the removal of orthodontic appliances and the termination of treatment.
Patient/Patient’s parent/Patient’s guardian has been informed that treatment has not been completed and that Won-Woo Park, DMD, MS recommends the continuation of treatment in order to obtain the best results.
I hereby release Won-Woo Park, DMD, MS, OoLi Orthodontics – AZ PHX, PC & OoLi Orthodontics - AZ Tempe, PC from any responsibility for all consequences caused by early termination of treatment.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Early Termination of Treatment
Agree & Sign