Teeth Whitening

Electronic Consent Form

{When you come for your appointment, we will ask you to fill out this electronic form}


You may feel a slight tingling or minor blanching of the gums, this is normal and will usually disappear in less than 4 hours. Your teeth will never be whiter than your genetic traits. White spots may appear if you had braces, or have porous enamel, this will usually disappear in 8 hours. The whitening gel is PH neutral and will not damage your enamel, caps, crowns or veneers.

***Please be advised, your teeth can only be whitened to a certain shade and cannot go whiter than your genetic traits allow. ***

If you answer YES to any of the questions below or if you have not had a dental cleaning in the last 6 months, please consult your dentist prior to use.

Please complete the form below which indicates your consent:

  • Complete ingredient information can be provided to you at the time of your appointment.

Schedule An Appointment or Consultation

Please utilize our handy booking calendar to book a service. You will receive a confirmation email shortly after. We are looking forward to seeing you soon!
(519) 854-7227