Minor Disclaimer

Procedure Description: I understand that teeth whitening is a cosmetic procedure that involves the use of bleaching agents and/or light technology to lighten the color of my child's teeth. The Company has explained the procedure to my satisfaction, including potential risks and benefits.

 

Risks and Discomfort: I understand that teeth whitening may cause temporary tooth sensitivity, gum irritation, or other potential side effects. I accept responsibility for any discomfort or adverse effects that may arise as a result of the procedure.

 

Results: I acknowledge that individual results may vary, and the Company cannot guarantee specific whitening outcomes. The final results will depend on factors such as my child's initial tooth color, lifestyle choices, and aftercare.

 

Aftercare Instructions: I agree to ensure that my child follows the post-whitening care instructions provided by the Company to maximize the longevity and effectiveness of the treatment.

 

Photographic Release: I grant 1smile permission to take photographs or video recordings of my child's teeth before and after the teeth whitening procedure, for documentation and marketing purposes. My child's personal information will remain confidential.

 

Payment: I understand that a deposit of $20 is required to be made to hold the appointment date and time for the teeth whitening service. The remaining balance payment for the services is due in full at the time of service.

 

Release and Waiver: I hereby release 1smile and its employees, agents, and representatives from any liability for any claims, damages, or injuries, including but not limited to personal injury or property damage, arising out of or in connection with the teeth whitening procedure, except to the extent caused by the Company's gross negligence or willful misconduct.

 

I HAVE READ AND UNDERSTOOD THIS CONSENT FORM AND AGREE TO ITS TERMS.