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Please fill out the following form
in order to participate in our service.
Date Of Appointment
Have you eve had teeth whitening done before?
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
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