Get Tooth Gem Consent Form

Filling out the Tooth Gem Consent Form is an essential step before having a tooth jewel applied. This guide provides clear, step-by-step instructions to help you navigate the online form with ease.

Follow the steps to complete the Tooth Gem Consent Form online

1. Press the ‘Get Form’ button to access the Tooth Gem Consent Form in your preferred editing tool.
2. Enter your name in the designated field. Make sure to use your full legal name as it appears on your identification.
3. Provide your date of birth by selecting or filling in the day, month, and year fields.
4. Fill in your address including street number and name, city, state, and zip code in the appropriate fields.
5. Include your phone number and email address for contact purposes. Ensure your email is accurate for follow-up communications.
6. Indicate your dentist's name and address, so that records can be accurately referenced.
7. List an emergency contact by including their name, relationship to you, and their phone number.
8. Answer questions regarding allergies to dental materials and whether the tooth you are choosing for the jewel is real. Be truthful in your responses.
9. Authorize the application of the Tooth Jewel by initialing next to the specific tooth or teeth you have chosen from the provided options.
10. Review the general information about Tooth Jewels and acknowledge your understanding by signing and dating the form.
11. Once you have completed all required fields, save your changes, and download or print the form for your records.
12. Share the signed form with the appropriate party as directed in the instructions.

Complete your Tooth Gem Consent Form online today to start your journey toward a sparkling smile!