Mentoring Form

Clear Aligner Mentoring – Case Introduction

Dentist Details

Full Name*

GDC Number*

Practice Name

Practice Address

Email Address*

Phone Number

Years Qualified

Clear Aligner Experience

Experience Level
No prior cases1–5 cases6–20 cases20+ cases

Aligner System Used
InvisalignSureSmileClearCorrectAngel AlignerOther

If Other, please specify

Patient Case (Non-Identifiable)

Patient Initials (e.g., AB)

Patient Age

Clinical Information

Problem List / Case Description

Treatment Objectives

Concerns / Support Needed (attachments, IPR, predictability, staging, refinements, etc.)

Upload supporting file (optional)

Consent

I confirm that no patient-identifiable data has been submitted and I consent to being contacted regarding mentoring.

Download

This is a draft agreement. All agreements will be bespoke and modified as appropriate for each clinician and case.

Fees for mentoring are bespoke and individual and will be discussed following review of the case proposal.

Download the mentorship agreement here (PDF)