The Early Removal Of Braces Consent Form is a critical document used in Dutch orthodontic practices when patients request the removal of their braces before completing their full treatment plan. This document becomes necessary when patients, for various reasons such as personal preference, financial circumstances, or other considerations, decide to terminate their orthodontic treatment earlier than initially planned. The form, compliant with Dutch healthcare legislation including the Medical Treatment Agreement Act (WGBO) and Healthcare Quality, Complaints and Disputes Act (Wkkgz), serves multiple purposes: it documents the patient's informed decision, outlines potential risks and consequences of early removal, addresses financial implications, and provides legal protection for both the healthcare provider and the patient. It must be properly executed before any early removal procedure can be performed, with special provisions for minors under Dutch law.

1. Patient Information: Patient's full name, date of birth, contact details, and treatment identification number

2. Treating Orthodontist Information: Name, registration number, and practice details of the treating orthodontist

3. Current Treatment Status: Description of the current stage of orthodontic treatment and original treatment plan

4. Reason for Early Removal: Documentation of the reason(s) for requesting early removal of braces

5. Risk Acknowledgment: Detailed list of potential risks and consequences of early braces removal

6. Financial Implications: Statement regarding any financial consequences of early treatment termination

7. Patient Declaration: Patient's confirmation of understanding and acceptance of risks

8. Consent Statement: Formal consent declaration for the early removal procedure

9. Signatures: Signature blocks for patient (or legal guardian), orthodontist, and witness