TEETH WHITENING CONSENT FORM

TEETH WHITENING

 

PATIENT INFORMATION:
 
MEDICAL HISTORY
 

Procedure Description:

I understand that I am receiving a Teeth Whitening treatment. Teeth whitening is a cosmetic dental procedure designed to lighten the natural color of my teeth by removing or reducing stains and discoloration caused by food, drinks, smoking, aging, or medications.

The treatment uses a professional whitening agent that is applied to the teeth and may be activated with a special light or left to work on its own, depending on the method used. The whitening agent penetrates the enamel to break down stain molecules, resulting in a brighter tooth shade.

Teeth whitening is non-invasive and does not involve drilling or injections. Some clients may experience temporary tooth sensitivity or mild gum irritation after the procedure. Results are often visible immediately, but the final shade may continue to improve over the next few days. Results vary from person to person, and multiple sessions or maintenance treatments may be needed to achieve or maintain the desired level of whitening.

Benefits and Risks:

I have been informed that the potential benefits of Teeth Whitening treatment may include:

• Brighter and whiter-looking teeth
• Reduction of stains caused by food, drinks, smoking, or aging
• Improved smile appearance and confidence
• More even tooth color
• Quick and noticeable cosmetic improvement

I understand that results vary from person to person and that teeth whitening does not change the natural structure of the teeth. Some individuals may require more than one session or maintenance treatments to achieve or maintain their desired shade.

I understand that there are potential risks and side effects associated with teeth whitening, including:

• Temporary tooth sensitivity
• Mild gum irritation
• Uneven whitening if there are existing dental restorations
• Temporary discomfort when consuming hot, cold, or sweet foods

Aftercare:

I agree to follow all post-treatment instructions provided by the clinician, including avoiding staining foods and drinks, maintaining good oral hygiene, and attending follow-up appointments if recommended. I understand that failure to follow aftercare instructions may affect my results or increase the risk of side effects.

Consent for Treatment:

I hereby consent to receive Teeth Whitening treatment at The Abram. I acknowledge that the clinician has explained the procedure, its purpose, potential benefits, and possible risks. I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction. I understand that results vary and that additional sessions or maintenance treatments may be recommended for optimal results.

Release of Liability:

I release The Abram, its staff, and representatives from any liability related to this treatment, except in cases of proven negligence or intentional misconduct.

Photography and Records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

I agree that all the above information is true and accurate to the best of my knowledge

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