Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Instagram*

You may be contacted via DM if no reply via Email

Pronouns*

Eg; she/her, they/them, he/him

Have you ever had any oral issues such as :

Do you wear any sort of retainer?

Invisalign, metal retainer, night mouth guard etc

Is this your first Tooth Gem?*

YesNoNo, but I got it done somewhere else

Swarovski Gem Pricing:

1 x Round Swarovski Gem - $80

2 x Round Swarovski Gems - $130

3 x Round Swarovski Gems - $150

(Additional round gems) - $40 each

1 x Shaped Swarovski Gem - $100

2 x Shaped gem - $180

(Additional shaped gems) $70 each

1 x Shaped Swarovski Gem + 1 x Round Gem - $165

1 x Opal Gem (Bello Opal) - $100 (Additional Opals are $80 each)

1x Tooth "Tattoo" - $65

(Additional Tooth Tattoo) - $50 each

1 x Gem Replacement - Within 1 month (by me only) - Free

1 x Gem Replacement - More than 1 month - Discount may be granted

Set Design Prices:1-2 Teeth

1 x Butterfly, Cherry, Flower, Paw Print, Cross, Winged Heart, Evil Eye, Waves, window/outline - $180

1 x Discoball, Chandelier/Pixie dust (whole tooth coverage) - $220

1 x Lucky Dip - $160

Freestyle Designs Prices:4-6 Teeth

(2-6 Teeth) - $220-$300 (depending on how many gems used)

(6+ Teeth) - *$350

*Free style Designs are when you want 2-6 (bottom,top or both) covered in multiple gems. You let me have creative freedom with the designs and this way it makes it alot cheaper for you compared to custom sets.

18K-22k Gold Tooth Charms:

(White & Yellow Gold) Gold does tend to last longer due to the flatness.

1 x Gold Charm - $180-$250 (depending on which design)

1 x Gold Charm + 1 Round Swarovski - $220

(Plenty of styles avaliable for pre-order with a 50% deposit required, can take 2-3 weeks, so order in advance of date wanting it applied).

Be sure to include which charm you have seen (on Stoned Smile Instagram) that you are interested in on this form.

Design Idea*

Eg - 1 gem, 1 x flower, 1 x Freestyle etc..

Description*

If you have no idea what you are after just yet, I'm more than happy to talk through some style options with you :).

Please upload a picture of both your teeth when smiling and your teeth when you are biting down if you are getting multiple teeth or a multiple tooth set.

Preferred day of the week:*

WeekdayWeekends

Preferred time of the day:*

Morning (10-12pm)Early (12pm-3pm)Afternoon (3:00pm-5:00pm)

If you are looking for a specific date, please list below those dates, so I can try to accommodate you.

INQUIRIES & ADDITIONAL COMMENTS (any known allergies please list below) :

*Please note if you are only looking at price estimates and NOT looking to book in an appointment.*

Are you 18+?

YesNoNo, but I will have an adult present with me.

Will you be bringing anyone with you to your appointment?

YesNo

Please Note:

A $35 deposit fee will be required once I have confirmed your booking. This will go towards the total of your booking amount.

The deposit fee is non refundable. If you are a no show, are more than 10 mins late or cancel less than 24 hours before your booked appointment, you will not be rufunded for this and you will have to pay an additonal $35 fee upon your next booking.

We understand life happens, so please communicate any changes as far in advance as possible to avoid this.

¯`·.·★ 𝕊𝕥𝕠𝕟𝕖𝕕 𝕊𝕞𝕚𝕝𝕖 𝔹𝕠𝕠𝕜𝕚𝕟𝕘 𝔽𝕠𝕣𝕞 ★·.·`¯

Swarovski Gem Pricing:

Set Design Prices:1-2 Teeth