Effective Date: November 2025
Welcome to McCullum Orthodontics. These Terms and Conditions (“Terms”) govern your use of our orthodontic services and website. By scheduling an appointment or using our services, you agree to these Terms.
1. Services
McCullum Orthodontics provides comprehensive orthodontic care including but not limited to:
- Traditional metal and clear braces
- Clear aligner therapy
- Early interceptive orthodontics
- Airway-focused orthodontic treatment
- Retainer therapy
- TMD/TMJ splint therapy
All treatment plans are customized to individual patient needs and may vary based on clinical evaluation.
2. Patient Responsibilities
Patients and parents/guardians agree to:
- Provide accurate medical and dental history information
- Attend scheduled appointments or provide 24-hour notice for cancellations
- Follow prescribed treatment plans and home care instructions
- Maintain regular cleaning appointments with their general dentist
- Promptly notify our office of any changes in contact information or insurance coverage
3. Financial Terms
Payment Policies
- Payment is due at the time of service unless prior arrangements have been made
- We accept cash, check, and major credit cards
- Financing options are available through approved third-party providers
Insurance
- We participate with select insurance plans
- Insurance verification is the patient’s responsibility
- We will file insurance claims as a courtesy, but patients remain responsible for all charges
- Insurance estimates are not guarantees of payment
4. Appointment Policies
Scheduling
- We strive to accommodate your scheduling needs
- Emergency appointments are available for established patients
Cancellations
- Please provide at least 24 hours notice for appointment changes
- Repeated no-shows or late cancellations may result in dismissal from the practice
5. Treatment Consent
- All treatments require informed consent
- Parents or legal guardians must provide consent for patients under 18
- Patients have the right to refuse treatment at any time
6. Privacy and Confidentiality
We comply with HIPAA regulations and maintain strict confidentiality of patient information. Our Notice of Privacy Practices provides detailed information about how we use and protect your health information.
7. Records and X-rays
- Orthodontic records remain property of McCullum Orthodontics
- Copies may be provided upon written request and payment of reasonable fees
- Records may be transferred directly to another provider with proper authorization
8. Treatment Risks and Limitations
Orthodontic treatment, like any medical procedure, carries certain risks including but not limited to:
- Root resorption
- Decalcification or decay if oral hygiene is inadequate
- Temporomandibular joint complications
- Relapse requiring additional treatment
Results vary by individual and cannot be guaranteed.
9. Emergency Care
For orthodontic emergencies during business hours, contact our office immediately. After-hours emergencies that cannot wait until the next business day should be directed to your general dentist or local emergency room.
10. Photography and Records
We may take photographs and other records for documentation and treatment planning. These remain confidential unless you provide written consent for other uses.
11. Termination of Treatment
Either party may terminate the doctor-patient relationship with written notice. If treatment is terminated before completion:
- Fees for services rendered are non-refundable
- We will provide emergency care for 30 days to allow transition to another provider
- Medical records will be transferred per your written authorization
12. Limitation of Liability
Our liability for any claim related to treatment shall not exceed the amount paid for the specific service in question.
13. Governing Law
These Terms are governed by the laws of the State of Indiana.
14. Changes to Terms
We reserve the right to modify these Terms at any time. Updated Terms will be posted in our office and on our website.
15. Contact Information
McCullum Orthodontics Jeffersonville, IN 47119 Phone: 812-213-9300 Email: frontdesk@mccullumortho.com
Acknowledgment
By signing below, I acknowledge that I have read, understood, and agree to these Terms and Conditions.
