• Teeth Whitening

    Consent Form

  • Client Intake

    Health & Dental Information
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Dental History (please select all that apply)

  • Waiver and Consent

    I hereby give consent to and authorize Sunset Silhouettes LLC to provide a teeth whitening treatment on me today. I understand teeth whitening involves using peroxide-based bleaching agents to whiten the teeth, but that bleaching will not whiten porcelain crowns or composite tooth-colored bondings.
  • Please read and check each of the following statements.

  • I confirm that I am at least 18 years of age, and by signing this consent form, I agree to the above information and the following:

    I understand the information given pertaining to a teeth whitening treatment, and I confirm that I do not have any conditions that would prevent the treatment from taking place today. I agree to inform my technician if I experience any discomfort during the procedure so it can be adjusted accordingly. I agree to waive all liability towards my technician and Sunset Silhouettes LLC for any injury or damages incurred due to any misrepresentation of my health. 

  • Date Signed
     - -
    2 digit month, 2 digit day, 4 digit year

  • FAQs

    Teeth Whitening

  • Is teeth whitening suitable for me?

    Teeth whitening is generally a safe and effective treatment to improve the appearance of your smile and boost your confidence. Results can vary from person to person and generally works best on yellow/brown stains compared to gray stains. Treatment is not recommended for anyone under 18 years of age, pregnant or breastfeeding, or if gum disease is present. A consultation at the beginning of your session will take place to ensure you are a candidate of a teeth whitening treatment. 

    Is teeth whitening safe?

    Teeth whitening treatments under a trained professional significantly reduces the risk of damage to tooth enamel and gums, and also reduces the chance of tooth sensitivity or root damage by using legitimate whitening products and procedures. You take the risk of seriously harming your teeth by obtaining teeth whitening from someone who is not professionally trained. 

    What are the side effects of teeth whitening?

    It's normal to experience some tooth sensitivity after a whitening treatment. This is temporary and usually last 1-3 days. Over the counter pain medication can be taken and dental products can be offered to help reduce symptoms. Using a toothpaste specifically for sensitive teeth is recommended before and after you undergo a teeth whitening treatment. You may also experience gum irritation which can happen if the whitening product gets onto your gums during the treatment. You may also experience white spots on the gums because of this as well, but this is also temporary and will resolve very quickly. 

    How long does a treatment take? 

    A teeth whitening session takes one hour to complete for the best results. 

    How white will my teeth get?

    The results will depend on each individual and the extent of their discoloration and condition of their teeth. Clients can generally see a difference of 5-10 shades whiter after just one session. Results can be maintained for up to a year with proper dental hygene and refraining from dark colored food/drinks in your diet after treatment. Whitening does not change the color of dental bonding/composite or any non-natural tooth restoration, including dental crowns, bridges, and veneers. 

    What do I need to do after treatment?

    It is crucial that you avoid food and drinks that can stain your teeth within at least the first 48 hours after your teeth whitening treatment, as your teeth are susceptible to absorbing new stains. You should also refrain from smoking for as long as possible.

    The following tips will help you to maintain your new, bright, white smile:

    • Avoid foods and drinks such as coffee, dark teas, red white, red pasta sauce, soy sauce, berries, etc. for at least the first 48 hours. If you must drink any of these liquids such as coffee, avoid letting it come in contact with the surface of your teeth by using a straw. 
    • Avoid using colored toothpaste and mouth wash for 48 hours. 
    • Avoid smoking, it causes heavy staining and discoloration to your teeth.
    • Avoid acidic foods such as lemons since they weaken the enamel. 
    • Schedule regular check-ups and cleanings with your dentist, while also maintaining proper oral hygiene at home, to help prevent staining and discoloration. Also, to keep your teeth healthy. 

  • Cancelation Policy

    Teeth Whitening

  • At Sunset Silhouettes LLC your appointments are very important to us and we understand that sometimes appointments need to be rescheduled or canceled. Because most of our services require preparation ahead of time to properly prepare the room for your session, we have cancelation policies in place. In order to provide you and others with excellent customer service and access to appointments during peek times, we kindly ask for the following considerations: 

    Cancelation fees

    • We respectfully request at least a 24 hour notice to reschedule or cancel your appointment. 
    • Less than a 24hour notice will result in your deposit being kept and 30% of your sessions total will be charged. 
    • More than 10 minutes late or a no call no show will result in your deposit being kept along with a 30% charge.

    This cancelation policy allows us time to inform our standby clients of any availability. Without sufficient notice, we end up turning away other clientele who could have filled that time slot. 

    Arrival time

    Please arrive to your appointment at least 10min early to go over any issues on your contract, and to have a quick consultation. 

     

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Photo & Video Release Form

    Teeth Whitening

  • I hereby give consent and grant permission for Sunset Silhouettes LLC to use specified photos and/or videos taken before, during, and after the treatment I have requested today. I understand that my identity will be protected and my name or social media will not be used in conjunction with the photos or videos taken unless I give permission. 

    I hereby waive any rights to inspect or approve any final photos and/or videos and agree that they may be used by Sunset Silhouettes LLC for marketing, social media, advertising, website, and any printed or digital media.

    Additionally I waive my rights to payment, royalties, or any other compensations that may arise from the use of my photos and/or videos that were obtained during my treatments.

    I confirm that I am at least 18 years of age and by signing this form, I acknowledge that I have completely read and understand the above release and agree to be bound thereby.  

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: