Teeth Whitening Consent Form Template

DENTAL WHITENING INTAKE AND CONSENT FORMS
A teeth whitening intake form is a document that a dental professional may ask a patient to fill out before undergoing a teeth whitening procedure.
As a teeth whitening professional, you need a well-designed and professional way of keeping track of your client's personal details, medical history, instructions, and consent approvals to avoid issues and protect   you and your business from possible litigation. This form book is just what you need for this. It also includes an index section to quickly locate every client's details. This form can be used as boutique, lead, mobile, and cosmetic whitening Client Record Book. Check below to view the content of this form.

CONTENT OF THE EDITABLE TEETH WHITENING CONSENT FORM

1. Client information section

• Name
• Address, city, state and ZIP
• Age
• Email and phone number
• Two emergency contact name and phone number
• Email list added request
• Referrer

2. Medical and cosmetic history

• Several medical questions about client's teeth.

3. Client special instructions/requests

• Record up to 7 client special requests or instructions

4. Consent and signature

• Client consent section to protect you and your business.

5. Official section

• Who reviewed the form?
• Date and signature
• Comments
• Was client accepted or not?
• Reason for rejection.
• Teeth whitening cost and discount (If any).
• Technician's name, date, signature.
• Manager name, date and signature

6. Business Information

• Name
• Email and Phone
• Address

AVAILABLE FORMATS

• PowerPoint (Editable)
• PDF
• LARGE 8.5 x 11 INCHES