Objective <p>Patients aiming for clear aligner therapy (CAT) have a distinct expectation regarding their orthodontic treatment. The aim of this prospective cohort study was to increase our knowledge on these specific patients’ needs, expectations, and concerns regarding CAT.</p> Methods <p>Patients, who were about to start CAT, were asked to answer both, a 32-item questionnaire addressing expectations regarding CAT, rated on a 10-point visual analogue scale, and the Oral Health Impact Profile (OHIP-14) questionnaire. In addition, demographic and clinical data were collected.</p> Results <p>A total of 82 patients participated (mean age 35 ± 12 years; 74.4% female). Patients strongly expected CAT to treat their malocclusion as effectively as orthodontic brackets (9.5 ± 0.9 points) and they would seek a second opinion if they were told treatment with CAT would not be possible (7.2 ± 3.3 points). In addition, patients appeared not willing to compromise on the planned treatment outcome, even if it would decrease treatment time (2.1 ± 2.3 points) or costs (2.4 ± 2.5 points). Further, they highly expected that the treatment result would endure for their lifetime (8.8 ± 2.1 points), they wanted to avoid visibility of orthodontic brackets (7.9 ± 2.8 points), prevent potential future problems (9.1 ± 1.5 points), and see a simulation of the expected treatment outcome (7.5 ± 2.9 points). The most important limitations with CAT expected by the participants were pain during treatment (7.7 ± 2.7 points) and restricted eating and drinking habits (7.3 ± 2.8 points).</p> Conclusion <p>Patients considering CAT exhibit high expectations, particularly regarding treatment outcomes, aesthetics, and efficiency and they appear not willing to accept any compromise due to choosing CAT.</p> Clinical relevance <p>Knowledge about these expectations can support our patient communication and thereby improve patients’ satisfaction with the treatment outcome.</p>