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Teeth Whitening
Information and
Informed Consent Form

7.  What are the special considerations?

The ZOOM In-Office whitening system uses a light source that emits ultraviolet light.  Although the output is less than half of the typical UVA exposure of commonly used facial and full body tanning units, the procedure incorporates significant protective and precautionary measures, all of which, our office follows.

Nevertheless, individuals undergoing PUVA therapy (Psoralen & UV Radiation), or other photo-chemotherapy, as well as those with melanoma should consult their physician prior to treatment.  Patients taking light sensitive drugs should also consult with their physician regarding possible photo-reaction.

In an attempt to help patients understand the benefits of certain dental treatments, we often times show them "before and after" photographs of procedures we have completed in this office.  With your permission, we would like to use your photographs, if suitable, for our "examples files." This may include in-office use, teaching seminars for other health care providers, and/or use on our website.

Next: Photographic Release and Authorization & Release
Back: 6.  What are some alternative treatment options?
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Printable Version of the Teeth Whitening Informed Consent Form