This Gift Certificate is issued by Dr. ___________________ (hereinafter referred to as Doctor or Doctor’s office). Telephone number________________ This Gift Certificate has no cash value. This Gift Certificate does not expire. This Gift Certificate is fully transferable to friends and family. Only one Gift Certificate may be used per Dental Patient/Gift Certificate holder per lifetime at Doctor’s office. No copies of this Gift Certificate will be accepted. This Gift Certificate is not valid or redeemable with any other offer. This Gift Certificate is good toward orthodontic services provided by Doctor’s office that have not already been contracted or started. This Gift Certificate can not be used towards previous and or contracted orthodontic services currently under treatment at Doctor’s office. This Gift Certificate must be surrendered at time dental services begin and or have been contracted. This Gift Certificate is only good at Doctor’s office. This Gift Certificate is only good for orthodontic dental services. No minimum purchase for dental services is required. This Gift Certificate may not be used for products sold in the Doctor’s office (i.e. toothbrushes, mouth rinse etc.). This Gift Certificate is good towards the gross normal fee schedule at Doctor’s office before any other adjustments. The presenter of this Gift Certificate agrees to abide by all State laws and Doctor’s office policies and procedures. It is the intent of Doctor’s office to provide the same level of high quality care to the Gift Certificate holder as it does to all other patients that utilize the care of named Doctor’s office. This Gift Certificate should not be re-sold. All insurance claim amounts shall be filed net of the Gift Certificate amount applied to the contract.