Teeth Whitening
  • Form

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  • Format: (000) 000-0000.
  • By signing below, you agree to the following:
    understand this agreement is binding and that I have read and fully understand all information listed above. I represent that Lam over the age of 18 or if under the age of 18, I have a parent and/or guardian signature below and that he/she consents to this procedure under these terms. [have completed this form to the best of my ability and knowledge and agree to inquire about questions I may have before "Exquisite Kurves" begins performing the procedure. I have been informed of and understand the contraindications to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my esthetician of any discomfort I may experience during the requested treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my esthetician and "Exquisite Kurves" for any injury or damages incurred due to any misrepresentation of my health history.

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  • Should be Empty: