Teeth whitening consent form 2025

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The document is a Teeth Whitening Consent Form where the signer acknowledges the purchase of a self-administered teeth whitening kit, understands the variability in results based on individual dental conditions, and is informed about potential risks such as gum and lip irritation. The form requires the signature and date from the purchaser.

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Click ‘Get Form’ to open the teeth whitening consent form in the editor.
Begin by entering your name in the designated field where it states 'I, ______, acknowledge...'. This personalizes the document and confirms your identity.
Review the section regarding results guarantee. Acknowledge your understanding of how different dental conditions may affect whitening results by checking the appropriate box provided.
In the potential risks section, read through the information carefully. You will need to check a box indicating that you understand these risks before proceeding.
Finally, sign your name in the signature field and enter today’s date. This finalizes your consent and agreement to proceed with the treatment.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Do you need a license to whiten teeth?

Teeth Whitening Licenses are required if your business is located in specific states around the country. Texas is one state where you do not need a license. California and Florida on the other hand, are two states that do require your business to hold a license.

What are the requirements for teeth whitening?

To qualify for teeth whitening treatments, patients must generally have good oral health. Dental caries (cavities) or excessive calculus buildup can interfere with whitening treatments and would need to be treated and removed before whitening.

What qualifications do I need to whiten my teeth?

It is super important though, to only go to a GDC (General Dental Council) registered dentist to have whitening carried out. We are legally the only people who can prescribe a whitening treatment.

Who is qualified to do teeth whitening?

Teeth whitening is a form of dentistry and should only be performed by a dentist or another regulated dental professional, such as a dental hygienist or dental therapist, on the prescription of a dentist.

What qualifications do I need for teeth whitening?

Always choose a qualified and GDC-registered dentist or dental professional to perform teeth whitening. Doing so will protect your health, ensure that the treatment is effective, and help you avoid legal issues. If youre considering teeth whitening, dont take unnecessary risks with unqualified technicians.

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What certification do you need to whiten teeth?

Do you have to be certified to whiten teeth? No, there are no laws in the US and Canada that require you to be certified to whiten teeth. However, there is a lot to professional teeth whitening that you need to know to be successful and keep your clients safe.

What is a dental consent form?

Obtaining general consent means that the patient has given you permission to proceed with treatment and released you from the possibility of being charged with battery. It also gives the dentist permission to perform minor restorative procedures, administer local anesthesia, and bill the patients insurance company.

Can I get my teeth professionally whitened at 16?

Teeth whitening is not permanent, but if your follow your dentists advice the effect may last for around 3 years. Its not done if youre 17 years old of younger, or you have unhealthy teeth or gums. Its also not recommended if you: are pregnant or breastfeeding.