TOOTH GEMS CONSENT FORM

TOOTH GEMS form

Hey welcome this, Alma Castro known as ONADAILY1x on Instagram Thank you for being here! I am currently located in South Los Angeles, CA. please go over my highlights for any general info/pricing before booking.
BEFORE & AFTER CARE💎
EAT BEFOREHAND & BRUSH YOUR TEETH GENTLY🪥

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AVOID TOUCHING OR PLAYING WITH YOUR GEM

FOR THE FIRST 24 HOURS AVOID THIS IS VERY IMPORTANT AVOID BITING TO ANYTHING SOLID OR HARD OR TO HOT OR COLD BEVERAGE AS IS TAKES 24 HRS FOR THE COMPOSITE TO SET AND STICK.

NO ELECTRIC TOOTH BRUSH OR WATER PIK FOR 24 HRS
USE SUPER SOFT TOOTH
BRUSH

AFTER 24 HOURS, CONTINUE GOOD ORAL CARE SUCH AS BRUSHING AND FLOSSING KEEP YOUR TEETH CLEAN TO AVOID PLAQUE BUILD
Name & Last Name

First NameLast Name
how did you hear from me
Preferred Pronouns
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
have you ever gotten tooth gems
Once the tooth gem is applied there may be * remaining adhesive surrounding the gem.Which may wear off within 1-2 weeks naturally. Tooth gems can last anywhere from 2-24 months. To remove your gem before its natural fall off, you may visit a professional dentistry office to remove access adhesive residue. Please note, there is a small chance that the chosen tooth may reject the tooth gem, if this occurs 1 week WITHIN APPLICATION, Alma castro will offer a complimentary replacement.To consent SIGN FULL NAME BELOW?
Teeth whitening sessions will not whiten the * tooth gem. PLEASE NOTE: alma castro is not responsible for the tooth gem falling off if you chose to place on your porcelain composite _ veneers.To consent SIGN FULL NAME BELOW
I _____ understand that Alma Castro is NOT responsible for any damage made to teeth during or after the tooth gem application. Tooth gem removal will be completed by a dentist or dentist professional and not attempted by myself.To consent SIGN FULL NAME BELOW
I understand it is my complete responsibility * to follow all pre appointment procedures and aftercare procedures to ensure the best results possibleTo consent SIGN FULL NAME BELOW
What would like to get?

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TOOTH GEMS form