Tooth Gem Consent Form

Thank you for choosing Cole Temp Studios for your tooth gem service.

This form is intended to ensure you understand the procedure, expected results, aftercare requirements, and any potential risks associated with cosmetic tooth gem application. Tooth gems are a non-invasive cosmetic enhancement that is bonded to the surface of a healthy natural tooth using professional dental-grade materials. This service is cosmetic only and is not a substitute for dental care or treatment.

Please read each section carefully and answer all questions honestly. If you have any concerns regarding your oral health, existing dental work, or the suitability of this service, please discuss them prior to your appointment. Your safety, comfort, and satisfaction are our highest priorities.

By signing this form, you acknowledge that you have read and understood the information provided, have had the opportunity to ask questions, and voluntarily consent to receiving this cosmetic service.

Health Questions

Client Acknowledgments

• I understand the tooth must be clean and dry.

• I understand tooth gems are cosmetic only.

• I understand the gem may naturally come off over time.

• I understand longevity varies depending on oral habits.

• I understand biting hard foods may shorten the life of my tooth gem.

• I understand I should not attempt to remove the gem myself.

• I understand removal should be performed by a dental professional or trained technician.

Contradictions

I understand this service should not be performed if I have:

• Untreated cavities

• Active gum disease

• Infection

• Loose teeth

• Damaged enamel on the application tooth

Liability Waiver

I understand that Cole Temp Studios is providing a cosmetic service only and is not providing dental treatment. I certify that I have disclosed any known dental conditions that may affect this service.

Consent

• I understand the procedure.

• I have had the opportunity to ask questions.

• I voluntarily consent to receiving this service.

I certify that the information provided on this form is accurate to the best of my knowledge. I understand that failure to disclose relevant dental conditions may affect the safety and longevity of my tooth gem application. I release Cole Temp Studios from liability arising from undisclosed dental conditions, failure to follow aftercare instructions, or normal wear of the cosmetic jewelry.