Clincheck Submission (#2)

Prescribing Clinician Details

Prior to completing the form below please make sure that you have already submitted your case to Invisalign® and the first Clincheck has already come back in order to allow us to carry out new modifications.

Patient Case Details

The Complete Aligner Programme’s Aligner Simulation Assistance (CA) User Agreement

The revolutionary Complete Aligner Programme will provide delegates with a one stop course covering A-Z of aligner therapy. The Aligner Simulation Assistant allows Clinicians to delegate their Clinchecks to our Orthodontic Specialists, to provide stress-free Specialist results every time.


1. The Aligner Simulation Assistant (ASA) as run by The Complete Aligner Programme (TCAP) provides services to registered orthodontists and dentists. We help these professionals as part of their complete professional diagnosis and treatment of their patients.

2. A proposed treatment plan or recommendation from ASA is NOT a replacement for the necessary treatment by a registered orthodontist or dentist. Rather ASA’s contribution and recommendations will depend directly on the treating doctor's own examination and diagnosis of their patients. Results may vary, and throughout the course of treatment, the registered orthodontist or dentist must closely follow and monitor the progress of treatment for each patient.

3. The services we provide, pursuant to this agreement are based on the specific representation by the undersigned, to The Complete Aligner Programme’s ASA that the user of the services herein and referenced hereby, is a registered orthodontist or dentist, in good standing, who is qualified to practice in this field and that he or she has the required knowledge and experience to utilize the services set forth herein with respect to their patients.

4. Once a modification is undertaken by ASA as instructed by the doctor, the registered orthodontist or dentist who signs this contract bears sole responsibility for any diagnosis and treatment as well as sole responsibility for treatment outcome from such diagnosis and/or treatment.

5. The undersigned acknowledges that ASA does not require the submission of records of the undersigned's patients. Our recommendations and evaluations are focused only on assessing the feasibility and enhancing the predictability of the planned ClinCheck movements. The undersigned treating doctor is solely and completely responsible and liable for integrating any suggestions and or recommendations made by us into their overall treatment plan.

6. The undersigned treating doctor bears sole responsibility for any diagnosis and treatment as well as sole responsibility for treatment outcome from such diagnosis and/or treatment. A case will never be ‘approved’ for manufacture by ASA as the treating doctor is responsible for the final outcome of the ClinCheck.

7. In the event any action is brought against ASA based on any services provided for herein, the undersigned expressly agrees to fully and completely indemnify, hold harmless and defend ASA against any such actions by any patients treated by the undersigned.

Cost: $295.00
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