Informed Consent Form

You have a right to be informed about your condition and its treatment, so that you may decide whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give, or withhold, your consent for treatment.

Please accept the below point
The nature and purpose of the treatment have been explained to me. I have read and understood this agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement.
I release staff, and Teeth Whitening Fairies from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns.
Note: All prices are subject to change without prior notice.
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By completing and submitting this form you agree to the terms and conditions above stated.
Click submit to complete this form.