TERMS AND CONDITIONS

By signing this Consent Form, I hereby give my consent to and authorize Teeth Whitening Beauty Bar to provide a Teeth Whitening treatment to me today. I acknowledge and agree to the following terms and conditions:

1. Treatment Description:
   Teeth Whitening involves using peroxide-based bleaching agents to whiten the teeth. I understand that this treatment will not whiten porcelain crowns, veneers, caps, composite tooth-colored bindings, or bridges beyond their natural color.

2. Voluntary Consent:
   I voluntarily elect to undergo this Teeth Whitening treatment, having had the nature, purpose, risks, and hazards of the treatment fully explained to me by Teeth Whitening Beauty Bar.

3. Potential Side Effects:
   I understand that there may be risks of side effects from this treatment, including but not limited to tooth sensitivity, pain, tingling, toothache, and irritation to the gums. I will inform the Technician of any discomfort experienced during the treatment so adjustments can be made accordingly. I will not hold my Technician responsible for any pain or discomfort during or after the treatment.

4. Understanding of Treatment Limitations:
   I acknowledge that this Teeth Whitening treatment will not affect the color of any restorations I may have, such as porcelain crowns, composite tooth-colored bonding, veneers, caps, or bridges. As a result, the outcome may result in uneven whitening if I have any teeth with restorations.

5. Suitability and Precautions:
   I understand that Teeth Whitening is not recommended for individuals with gum disease, teeth with worn enamel, or cavities. These conditions should be treated before undergoing any teeth whitening procedure.

6. Post-Treatment Care:
   I understand that after the treatment, I should avoid smoking and consuming dark-colored foods and beverages for at least 24 hours. Foods and beverages to avoid include, but are not limited to, red wine, sports drinks, carbonated beverages (both light and dark), black tea, coffee, berries, and sauces such as soy, curry, and tomato.

7. Home Care Instructions:
   I have read and understood the post-treatment home care instructions provided to me and acknowledge the importance of following these instructions.

8. Photograph and Video Consent:
   I hereby give consent and grant permission for Teeth Whitening Beauty Bar to use specified photographs and/or videos taken before, during, and after the treatment/procedure I have requested today. I understand that my identity will be protected, and neither my full face nor my name will be used in conjunction with the photographs and/or video.
   I hereby waive any right to inspect or approve the finished photographs and/or video and agree that they may be used by Teeth Whitening Beauty Bar in their marketing, social media, advertising, any printed and digital media, and on their website.
   Additionally, I waive my right to payment, royalties, or any other compensation that may arise from the use of these photographs and/or video.

9. Age and Agreement:
   I confirm that I am at least 18 years of age. By signing this Consent Form, I acknowledge and agree to the following:

   • I understand the information provided about the Teeth Whitening treatment and confirm that I do not have any conditions that would make this treatment unsuitable.

   • I agree to inform my Technician if I experience any discomfort during the procedure so they can make necessary adjustments.

   • I waive all liability towards my Technician and Teeth Whitening Beauty Bar for any injury or damages incurred due to any misrepresentation of my health condition.

10. Non-Refundable Policy:
    I understand that all purchases of Teeth Whitening services are non-refundable. While individual results may vary, Teeth Whitening Beauty Bar is committed to making every effort to ensure my satisfaction with the treatment outcome.