Consent form
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By completing and signing this consent form I am agreeing to the following: I consent to a tooth gem at this event with Molarbaby. I agree to follow the aftercare procedures given to me by the technician and to read follow up form emailed. I have alerted Molarbaby of any medical conditions I may have. I acknowledge and understand that tooth gems do not adhere to crowns, caps, porcelain veneers, for a long period of time. Tooth gems are best placed onto a real tooth to ensure longevity. Tooth gems are better placed high on the tooth or in the centre, as the edges of the teeth sink into food. If you decide you want your tooth gem on the lowest point of your tooth, your technician can't ensure longevity and is not responsible if the tooth gem falls off. Tooth gems are non-invasive. They do not cause damage to the tooth or enamel and are both semi-permanent and mostly reversible. Any damage caused due to poor aftercare is not Molaraby's responsibility. Once the tooth gem has been applied, there may be some remaining adhesive surrounding the tooth gem. This may wear off within 1-2 weeks from general brushing and eating. Tooth gems can last anywhere from 3-24 months. If you wish to remove your tooth gem before it naturally falls off, it has to be done via a dental appointment. Once your tooth gem does come away naturally, there may still be some residual adhesive remaining on the tooth. This too can easily be removed by a Dental Clinician. If you undergo frequent teeth whitening sessions, or use at-home teeth whitening products, the area underneath the tooth gem will not receive the whitening treatment. I agree to not remove the gem myself and if I want to remove it to book in with Molarbaby or another registered dental clinican. I take full responsibility of my tooth gem. Molarbaby is not liable for any issues that may arise following my tooth gem procedure. Any following costs associated with tooth gem is a cost patient/ client take's responsibility for.
By signing below I consent to having read and consent to release of liability, and waiver of all claims
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