• MOBGEMZ LIABILITY INTAKE FORM

    Thank you for choosing Us
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  • What service(s) are you getting done?
  • Have you ever gotten a tooth gem or teeth whitening done by another technician?
  • Have you had professional whitening done before?
  • Do you have any concerns about professional whitening ,if so why?

  • Do you have any false crowned, capped, veneers or fillings?

  • Health History | Please check any of the following that applies to you

  • Mobgemz Disclaimer:

    The quality of your tooth and enamel vary from person to person as some gems may fall out within a few days, while some may last up to a year. Please keep in mind that these are semi permanent and are not drilled in. 1 of 10 clients lose their gem possibly due to lack of aftercare or the tooth is not suited for the gem as it works best on a flat area. We do our best to ensure your gem stays on for a maximum length. We do not place gems on false, crowned, capped. Veneers, or fillings, and do not guarantee long placement on retainers.

    Teeth whitening is designed to lighten the colour of your teeth. Significant whitening can be achieved in the vast majority of cases. Everyone’s teeth respond differently and have their own natural “stop” point for whitening results.  When done properly, the whitening will not harm your teeth or gums. However, just like any other treatment, it has some inherent risks and limitations that should be considered when deciding to have the treatment done. It is recommended to consult your dentist before using any teeth whitening systems. 


    Temporary tooth sensitivity may occur with this product but should dissipate within a few hours. If the product comes into contact with any soft tissue (including gums, lips and skin), white spots may appear which will dissipate within a few minutes. 


    This product is not for people who are pregnant or nursing, or under the age of 18. 


    If you have tooth decay, exposed roots, gum disease, braces, or recent oral surgery this treatment may cause sensitivity and should be discussed prior to having this treatment. Teeth whitening is intended for natural teeth only. This product will not whiten caps, crowns, veneers, fillings, dentures or other types of dental work. 

     

     

  • Mobgemz Refund Policy
  • Mobgemz Cancellation Policy

    If you need to reschedule or cancel your appointment you can send us an email at mobgemz@gmail.com. Please keep in mind that all deposits are non refundable even if you cancel within 24 hours. Appointment deposits are only transferrable before 24 hours, all flash sale appointments are also non refundable, (please review the refund policies above) We ask that you please inform us at least 24 hours in advance to reschedule your appointments.  Deposits and flash sale appointments are forfeited if you do not show up.

  • Do you agree to have pictures/video taken during or after this treatment and allow them to be shared on socila media
  • Mobgemz Liability Information
  • Have you read all the information above?
  • Date
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