Teeth Whitening

Please fill out the following form
in order to participate in our service.

First name

Last name

Date Of Appointment

Have you eve had teeth whitening done before?

Yes

When was you last dental check up?

Under 6 months

Over 6 months

By checking the box below, you understand and consent to performing self-administered whitening treatments at Glitz Spray Tanning . You also confirm that you have read and understood this entire agreement, including the potential risks, complications, and side effects, versus the benefits of whitening treatments. You also understand the need for follow-up care and proper maintenance in order to maintain a lighter tooth color shade over time. I understand that I am performing this treatment under my own responsibility and care, and that I must follow all instructions during the process. I certify to the best of my knowledge, that my teeth and gums are healthy and that I am eligible for treatment and hold no responsibility to the Technician at Glitz Spray Tanning

Initials

BLACK FRIDAY Gift Cards ! CLICK HERE
Pay $40 get $50 Code: BLACKFRI10 or pay $100 get $125 Code: BLACKFRI25
Dec Sale! Book a teeth whitening & get a spray tan for only $10 - ($105)

Teeth Whitening

Fall Hours

Location

Get In Touch

BLACK FRIDAY Gift Cards ! CLICK HERE Pay $40 get $50 Code: BLACKFRI10 or pay $100 get $125 Code: BLACKFRI25 Dec Sale! Book a teeth whitening & get a spray tan for only $10 - ($105)

Teeth Whitening

Fall Hours

Location

Get In Touch

BLACK FRIDAY Gift Cards ! CLICK HERE
Pay $40 get $50 Code: BLACKFRI10 or pay $100 get $125 Code: BLACKFRI25
Dec Sale! Book a teeth whitening & get a spray tan for only $10 - ($105)