Teeth Whitening Release Form

Waiver: Acknowledgment and Consent: I, the undersigned, acknowledge and agree to the following: Informed Consent: I understand that teeth whitening involves the application of whitening agents to my teeth. I have been informed about the procedure and the expected results. Potential Risks: I am aware that potential risks include, but are not limited to, tooth sensitivity, gum / soft tissue irritation, blanching, or uneven whitening. I have been advised on how to manage any potential side effects. No Guarantee: I understand that results may vary and that there are no guarantees regarding the degree of whitening or the duration of the results.Pre-existing Conditions: I confirm that I have disclosed any existing dental conditions, allergies, or sensitivities to the service provider. I understand that failure to do so may affect the outcome or safety of the treatment. No Guarantee: I understand that results may vary and that there are no guarantees regarding the degree of whitening or the duration of the results. Release of Liability: I hereby release, discharge, and hold harmless the service provider and their staff from any and all claims, liabilities, or damages arising out of or in connection with the teeth whitening procedure.