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Free Consults vs. Consultation Fees

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Free Consults vs. Consultation Fees

How orthodontists handle the unreasonable few

Orthodontists can debate brackets versus aligners all day. Still, few topics spark as much tension behind closed doors as this one: Should the initial consultation be complimentary, or should patients pay for the clinician’s time?

In many communities, “free consult” has become so standard that families expect it, comparison-shop for it, and even treat it as a checkbox on a list of competing offices. At the same time, more orthodontists are quietly questioning whether the specialty has trained the public to undervalue what happens in that first chair-side conversation. Not just the quick look at crowding, but the clinical judgment, growth assessment, and chair time spent explaining timing and options before a single bracket is placed.

So what is a consultation, really: a courtesy, a loss leader, a professional service, or all three?


The case for charging: Our time has value
The argument for a fee often starts with a simple comparison. Patients routinely pay for evaluations elsewhere in health care and dentistry. They also pay service fees in countless non-medical settings without hesitation. Orthodontists who favor charging for consults tend to frame the first visit as professional work, not a retail preview.

From this standpoint, if the consultation is free, patients may subconsciously file orthodontics under optional consumer purchases rather than health care. That mindset can invite fee negotiation, multiple opinions, and the perception that orthodontists are interchangeable providers differentiated primarily by price, payment terms, or convenience.

Supporters of consultation fees also note that even when treatment is not yet indicated, those visits still consume real resources, including clinical supplies and staff time for scheduling and follow-up, and operatory turnover. When offices provide multiple complementary observation visits over several years or spend significant time with adults who never move forward, the cumulative cost adds up.

Some orthodontists feel the scope of discussion during a complimentary first visit has expanded over time, sometimes drifting beyond a simple screening into detailed planning conversations. Even when the first visit is intended to be brief, it can easily stretch into deeper explanations that require experience, judgment, and focus.

From this perspective, even a modest fee can shift expectations. It signals that the orthodontist’s time has value and that the appointment is more than an introductory meeting. Many who take this approach emphasize that the fee is less about revenue and more about alignment, filtering out casual shoppers and attracting patients who are prepared to engage.


The case for free: It is not free, it is marketing
On the other side of the debate, many orthodontists argue that complimentary consultations are a smart business move. The initial visit is a classic loss leader, similar to advertising, community outreach, or other marketing efforts that do not convert 100 percent of the time.

Practices that keep consults complimentary often view the first visit as the most effective way to fill starts, build goodwill, and lower the barrier for hesitant families. A small fee can have an outsized deterrent effect, even for families who can afford treatment. Add a charge too early, and the practice may lose not only price shoppers but also high-quality families who simply choose the path of least resistance.

There is also a relationship argument. Many patients are not ready when they first walk through the door. They are exploring options, gathering information, or trying to understand timing. A positive first experience, without a financial hurdle, can establish trust that brings them back months or even years later. In that sense, the complimentary consult is an investment in a future relationship rather than a giveaway.

Supporters of free consults also note that orthodontics ultimately profits from starts, not screenings. If charging causes even a small percentage of families to never schedule, the long-term financial impact may outweigh any short-term gain from consultation fees.


The real fault line: Screening versus consultation
A pattern that emerges across practice models is that disagreements are not always about charging versus not charging. It is about defining what happens at the first visit.

In many offices, the initial appointment is a screening: a clinical look, a discussion of concerns, and a simple answer to whether treatment is needed now, later, or not at all. When the visit stays in that lane, the time investment is controlled, and offering it as a courtesy feels reasonable.

Tension arises when that screening quietly turns into something more. Once the discussion shifts into detailed planning, complex mechanics, or interdisciplinary considerations, many orthodontists consider the visit to have crossed into consultation territory. That distinction matters, and some practices respond by charging once that line is crossed rather than at the door.

Others charge for records instead of the exam itself, using that step as the commitment point. In those models, the consult becomes the second visit, during which diagnosis, planning, and fees are presented after the patient has demonstrated intent.


Adult cases, complexity, and effort
For some practices, the most significant strain does not come from adolescent screenings but from adult consultations. These visits may involve higher expectations, more questions, coordination with other providers, or discussions about limitations and risks. The time and mental energy required can be significant even if treatment never begins.

In response, some orthodontists charge selectively, applying fees only when the consultation moves beyond a basic exam or when advanced planning is requested. Others apply the fee toward treatment, framing it as a deposit rather than a standalone charge.


Market realities and professional identity
Even orthodontists who believe strongly in charging acknowledge a difficult reality. In many competitive markets, being the first office to introduce a consultation fee can feel risky. If neighboring practices continue to advertise complimentary exams, the office that charges may never get the chance to demonstrate its value.

That reality forces a practical question. Is the goal to maximize access and volume, or to redefine how orthodontic expertise is perceived? Practices with strong reputations, full schedules, or defined niches may be better positioned to charge without consequence. Others may decide that complimentary consults remain necessary to compete.


Where do you stand?
If complimentary consultations have become the default, even among orthodontists who privately question their value, it raises an uncomfortable question. Is the profession prioritizing patient access, or hesitating to challenge a deeply ingrained expectation?

Should orthodontists continue offering complimentary initial consultations as the price of competing in today’s market, or is it time to normalize charging for professional evaluation, even if it means seeing fewer patients at the front door? 
What’s your take?

Share your thoughts in the comments below.

Hot Topic articles draw inspiration from active online discussions among orthodontists. Written by the editorial team with the assistance of AI, each piece is thoughtfully developed and refined under full editorial oversight.
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December 2025
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