Tooth Gem Waiver & Consent Form

Please read each statement carefully and check each box to confirm you understand and agree. Tooth gems are a cosmetic service and may carry certain risks. By completing this form, you acknowledge that you are choosing to undergo this procedure voluntarily, have disclosed all relevant health information, and accept responsibility for your aftercare and results.

At the end of this form, please provide your full name and today’s date as your digital signature.