Align Clinic

    Align Clinic, LLC

    Scoliosis Patient Update

    Note: It is critical to closely monitor the patient at 9, 12, and 15 months of wear so the brace is not too short for the patient. A short brace can have negative effects.

    Image/Information Release

    I hereby give Align Clinic, LLC consent to obtain and release information and to photograph my child’s image to be used in the following ways:

    • Communicate with other scoliosis professionals (ie: Dr. Rigo, Schroth PTs, referring physician/staff, and others)

    • Submit to insurance companies to meet coverage criteria.

    Please check that all information is completed and try to submit the form until you receive a successfully sent message, thanks.

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