Orthodontic Treatment Fee QuotationEnter Patients Name D:O:B MM slash DD slash YYYY Consultation Date MM slash DD slash YYYY Oral Health excellent good poor I would recommend a hygiene visit fillings a hygiene visit and fillings Please select one if relevant There is Crowding in the upper arches There is Crowding in the lower arches There is Crowding in the upper and lower arches Please select one if relevant There is Spacing in the upper arches There is Spacing in the lower arches There is Spacing in the upper and lower arches Please select one if relevant During the treatment we may require extraction of the tooth, you will be advised regarding the timing of this when appropriate. During the treatment we may require extraction of the teeth, you will be advised regarding the timing of this when appropriate. The patient has an overjet of The patient has an overjet of 1mm The patient has an overjet of 3mm The patient has an overjet of 5mm The patient has an overjet of 10mm Please select if relevant The patient has primary and adult teeth present Please select if relevant The patient has a supernumerary tooth which will need to be extracted. I would recommend the following treatment: Upper fixed appliance Lower fixed appliance Upper and lower fixed appliance I would recommend the following treatment: A Swartz plate A Bite plate A Clarke Twin Block To Reduce mandibular growth maxillary growth And Reduce overcrowding overjet To Help align the Dentition further reduce the overjet Or Please return to us inPlease enter a number from 1 to 12.Please enter any additional comments here: