Yet another transfer patient has found his way to your door via your most loyal referrer. Unlike the other orthodontists in your town, your reputation for accepting transfers has targeted you as a prime recipient of patients who are currently in fixed appliance therapy. According to Steven's divorced father, Steven began treatment for a severe Class II malocclusion approximately a year ago. He had been living with his mother but has moved in with his father for the foreseeable future. Although you have repeatedly attempted to obtain his treatment plan and financial history from the previous orthodontist, no transfer information of any kind has been sent. You'd like to be as fair as possible with regard to treatment fees, but your difficulty in obtaining his history is becoming increasingly frustrating for you and your staff. What is the original orthodontist's ethical responsibility in the transfer of care? Should the original orthodontist disclose the financial arrangements between himself and the patient or parent? Is there any ethical obligation for the recipient orthodontist to accept the original orthodontist's fees? Must the recipient orthodontist verify that the patient's account with the original orthodontist has been sufficiently satisfied? Many of us who accept transfer cases have grappled with these questions—questions that get increasingly awkward if we choose to remain empathetic to the personal burdens of our patients and their parents. This ethical topic has been of interest for the last century. Despite the increased sophistication of appliance designs and therapeutic options during our specialty's evolution, transfer dilemmas have endured. Many of us decline to accept transfer patients altogether. We certainly have the right to do so as we execute our own autonomy, but are we serving our patients unselfishly? With respect to the establishment of fees for transfer cases, consider this historic passage from an intriguing 1918 editorial written by Dr Martin Dewey.[T]he only logical way to adjust the question of fees in the transfer of patients, so as to be perfectly satisfacory to the patient and to the orthodontist, is for the first man to collect such a fee as he thinks he is entitled. The patient should then be sent to the other orthodontist with the understanding that he will have to make financial arrangements with the second man … the man who begins the treatment of a case of malocclusion should not attempt to arrange the fee for the second man, because conditions may differ in the two localities, or the man may … have a different plan for naming fees, and each one should be allowed to make his fee accordingly.1Dewey M. Editorial: the ethics of orthodontic patients.Int J Orthod. 1918; 4: 483-494Abstract Full Text PDF Scopus (2) Google Scholar The ethical position regarding this issue has varied minimally in almost a century. Although some orthodontists attempt to maintain approximately the same fee structure as the original orthodontist, this decision is relegated to the discretion of the new orthodontist. Although the American Association of Orthodontists has developed a comprehensive transfer form that summarizes all essential information including financial history, use of the form is voluntary.2Dillard K. Personal communication, February 2, 2017.Google Scholar Whereas it is courteous and desirable for the initial and new orthodontist to communicate regarding a transfer patient, there is no ethical or legal responsibility to do so. Consider this regarding treatment of a transfer patient: “It is not unethical to remove appliances from, or to continue treatment of, a patient not of record upon request by that patient; provided, that substantial effort should be made to determine the reason for the request from the patient and, with the patient's consent, consult with the patient's practitioner prior to such removal or continuation of treatment.”3AAO Principles of Ethics and Code of Professional Conduct, 2009; Sec. VI (D-E):7.Google Scholar But the patient could prohibit the recipient orthodontist from contacting the initial orthodontist. The decision to accept the case would then be relegated to the autonomy of the recipient orthodontist. In Steven's case as in others, your decision to place the patient's welfare above your own concerns and interests by accepting him for care is the essence of professionalism. Sometimes the establishment of trust and confidence in your service—which define patient welfare—transcends that of dollars and cents.