Tooth Gem Client Consent Form

Client Information

Tooth gems are a cosmetic dental accessory bonded to the surface of a natural tooth using dental-grade adhesive. No drilling or permanent alteration to the tooth is involved when applied correctly and professionally.

Liability and Consent

I acknowledge that:

• Tooth gem application is a non-medical cosmetic service.

• The practitioner is not a dentist.

• No guarantee has been made regarding longevity or appearance.

• I accept full responsibility for any aftercare and future dental consideration.

I give my full informed consent to proceed with tooth gem application.