New Patient Registration

1.this is a procedure where we bond a thin film of a dental material(composite bonding)on your tooth outter surface Material name :IPS EMPRESS DIRECT - IVOCLARVIVADENT.Also There are other brands that can be used to creat the thin layers that makes teeth white and straight. The material has a variety of uses in dentistry ,It is bonded to the enamel surface by using the universal bond there are main 4 shades BL1,2,3,4.2. Shade selection is a patient desire only without interfrence from the dentist 3. Usually after applying the material to the tooth outtrer surface you will feel your teeth size is bigger but this is just a feeling will fade within 2-3 days.4. Usually you will feel uncomfortable for one or two weeks during biting or chewing food and your teeth are not chewing food properly this will fade away within one or two weeks.5. You may feel that some letters are not pronounced correctly it will be back to normal within couple of weeks.6. During first week avoid any staining food or drink and brush your veneers with a a-hard tooth brush and whitening tooth paste.7. Life time for this technique is 2 to 9 years during this period you should visit the clinic every 3 months for a check up and brush your teeth 3 times daily To avoid any caries or gingivitis.8. This layer can break if you bite hard objects like nails or plastic or hard objects Then you can visit us to repair it 9. During first week one or two layers can break we replace them.10. You have first one month to repair the layers for free then payment for repairs after the first month depend on the clinic prices11. Any time you don’t want the layers on the teeth you can visit the clinic to remove it12. all cosmetic techniques were explained including:crown,veneers,labial resin veneers,braces and customer choose labial veneers composite to enhance shape and color Instructions were given for how to care for the labial veneers And also the informed that these veneers can cause caries and gingival inflammation in case no good care or follow ups every 3 months are made.Also informed that these veneers can break or discolor if no proper brushing and eating habits are followed and informed that Life time of the labial resin veneers are 2 years usually depending on care and hygiene.13. Patient understood all information in a clear way and decided to the labial resin veneers for upper and Lower teeth after choosing the shade and approving the mock up.14. After the procedure is done and you want to remove it you pay 100USD for removal of the layers and no refund for the paid amount.15. Patient choose labial veneers composite to enhance shape and color16. Instructions were given for how to care for the labial veneers17. Patient understood all information in a clear way and decided to the labial resin veneers for upper and Lower teeth after choosing the shade and approving the mock up18. Patient has seen a teeth demo with the selected shade and he APPROVED FOR MOCK - UP by signing the document i declare i have read and understand and agreed on this instructions

1. PROCEDURE DETAILS
I, the undersigned, authorize the profesionals and their team to perform a dental veneers procedure. This treatment involves  bonding of custom-made veneers to the front surfaces of my teeth to improve their appearance.

2. UNDERSTANDING OF THE PROCEDURE
I understand that:
• The veneers are custome made and involve bonding to enamel.
• The procedure is cosmetic and not medically necessary.
• The color, shape, and size of the veneers will be discussed and approved by me before finalization,through a demo

3. RISKS AND EXPECTATIONS
I have been informed of the potential risks, including but not limited to:
• Tooth sensitivity.
• Changes in bite alignment.
• Possible need for future replacements or adjustments.

4. NON-REFUNDABLE POLICY
I acknowledge and agree that:
• The veneers are custom-made and designed specifically for my teeth.
• Once the process has begun, the procedure is non-refundable, regardless of any dissatisfaction with the final result.

5. PATIENT RESPONSIBILITIES
I agree to:
• Follow all post-procedure care instructions provided by the dental team.
• Return for any necessary follow-up visits.

6. CONSENT
I confirm that I have had the opportunity TO SEE A DEMO/MOCK UP FOR THE PROCEDURE AND to ask questions and discuss my concerns with the professionals. I have been given sufficient information about the procedure, risks, and non-refundable policy to make an informed decision.