Teeth Whitening Consent Form - This information has been given to me so that i can make an informed decision about having my teeth whitened. My dentist has informed me that there is a level of discoloration present on my teeth; I hereby authorize dr.wiesenmayer to perform home bleaching/ internal bleaching procedure on tooth (teeth) #_________________________________, and i understand that this is an elective, urgent, or emergency procedure (circle one). Web teeth will fade back towards their original color over time and may require repeated whitening from time to time, purchased at the patient’s expense. Sometimes the gums can go white during whitening; To maintain teeth at their optimal whiteness, it is. Web informed consent for philips zoom whitespeed tooth whitening treatment. Web this informed consent form. Web tooth whitening consent form dear «patient.title» «patient.lastname» this information is to help you make an informed decision about having tooth whitening. Web description of the procedure.
Web description of the procedure. Web teeth will fade back towards their original color over time and may require repeated whitening from time to time, purchased at the patient’s expense. Web home whitening/ internal bleaching consent. My dentist has informed me that there is a level of discoloration present on my teeth; This is natural and is dependent on diet. Sometimes the gums can go white during whitening; Web this informed consent form. To maintain teeth at their optimal whiteness, it is. I hereby authorize dr.wiesenmayer to perform home bleaching/ internal bleaching procedure on tooth (teeth) #_________________________________, and i understand that this is an elective, urgent, or emergency procedure (circle one). Web informed consent for philips zoom whitespeed tooth whitening treatment. Tooth whitening is not permanent and teeth may regress in shade somewhat. I have read and understand this consent form and wish to consent to, and proceed with, whitening treatment. This information has been given to me so that i can make an informed decision about having my teeth whitened. Web tooth whitening consent form dear «patient.title» «patient.lastname» this information is to help you make an informed decision about having tooth whitening. I have the right to ask questions about any procedure before agreeing to undergo the procedure.