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John Ashton Vellequette, DDS & Associates 877 W. Fremont Avenue, Ste. L3, Sunnyvale, CA 94087 (408) 2457500 Fax (866) 3062186INFORMED CONSENT FOR OFFICE WHITENINGPatient: Date: General Information:
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How to fill out bleaching informationinformed consent
How to fill out bleaching informationinformed consent
01
Read the entire document of the bleaching information informed consent form to understand the purpose and potential risks of the bleaching procedure.
02
Fill in your personal details, such as your full name and contact information, accurately.
03
Consult with your dentist or healthcare provider to clarify any doubts or concerns regarding the bleaching procedure before filling out the form.
04
Provide your signature at the bottom of the form to indicate that you have understood the information presented and give your consent for the bleaching procedure.
05
Make sure to keep a copy of the filled out bleaching information informed consent form for your reference and records.
Who needs bleaching informationinformed consent?
01
Individuals who are planning to undergo a bleaching procedure for tooth whitening purposes need the bleaching information informed consent.
02
This form ensures that the individual is aware of the potential risks, benefits, and alternatives of the bleaching procedure and gives their informed consent before proceeding with the treatment.
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