Clinic classification
Record the reason and criteria for the moderate-difficulty designation.

UNDERSTAND YOUR QUOTATION
Confirm each service below in your written quotation. This checklist does not mean that every stage is included in the listed item.
Record the reason and criteria for the moderate-difficulty designation.
Identify the underlying treatment, appliance and covered scope in the base quotation.
Specify the work covered by this fee rather than relying on the category name alone.
Confirm whether the supplement is a single charge per case or subject to other terms.
Check examinations, appliances, reviews, retention or other items against the complete quote; this supplement does not establish their inclusion.
Ask how a revised classification, changed treatment or further charges would be reviewed and communicated.
Educational illustrations. Components, clinical suitability and the agreed service scope require an individual plan.
BEFORE YOU DECIDE
The displayed amount is the moderate-complexity supplement per case. Add it to the confirmed base quotation and any other separately agreed items when reviewing the overall cost.
A complexity fee does not specify a treatment duration or appointment allowance. The clinician must explain the proposed schedule and continuing-care arrangements.
Illustrative planning scenes. Your written quote and clinical plan define the scope and appointments.
YOUR NEXT STEP
Bring the base quotation and your questions about the moderate classification, added work and charging terms together before proceeding.
Clinical suitability and appointment dates require confirmation. This form is not for emergencies.
Moderate Orthodontic Complexity Supplement in China