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To the CLIENT: 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 Pre/ Post Care: Undiagnosed dental decay or other undiagnosed oral problems may react to the whitening process. It is therefore essential a full examination be carried out prior to any whitening treatment. (please notify us if any active issues are occurring with teeth currently & no antibiotics 3 days prior)
The nature and purpose of the treatment have been explained to me. I have read and understand this agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement.
I release The Natural Place & staff, and specific technicians 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.
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