Teeth Whitening Information
 

Today we are performing a teeth whitening procedure. The process is 3x 15min cycles. I have adhered to my pre treatment instructions and have not brushed within the last 3hrs. I understand that this can affect the treatment results.
 

Clients should be 16yrs + and can not be pregnant/ breastfeeding.
 

GUM WHITENING: Gum whitening can happen and it should past within a few hours.
 

FLUROSIS: Teeth whitening can bring up fluorosis. This can sometimes leave whiter patches on the teeth. They will fade but they will ultimately be a bit brighter than the teeth, I understand that this is not known until treatment has at least done a single 15min cycle.
 

DRY LIPS: Dry lips can occur during the treatment please advise tech asap.
 

SENSITIVITY: Teeth can get sensitive after the treatment. sensitivity will vary from client to client.

I authorized Lift and Shape to perform this procedure as part of my treatment.
 

I understand the complications and risks that might happen as a result of this procedure. However, I still like to proceed.
 

I release and hold harmless Lift and Shape against any claims, damages, costs, which may occur during or after the procedure.
 

I understand that I need to follow the pre-care and post-care instructions given to me. I understand that no refunds are given.
 

I understand the results vary from client to client and are not guaranteed.
 

By signing this consent, I confirm that I have read and understood all the information indicated in this document. I also assure you that I'm of legal age. I fully accept all responsibilities for these or any other complications that may occur during the procedure.