Teeth Whitening Intake Form

• DaVinci products will not damage existing dental work.
• DaVinci products will remove stains from existing dental work but will not whiten them beyond their original color.
• White spots may appear more prevalent directly after whitening, but the contrast will lessen within 24 hours.
• Everyone’s teeth respond differently and have their own natural “stop” point for whitening results.
• Teeth may feel temporary sensitivity; sensitivity is typically minor and gone within 24 hours. You may choose to purchase a desensitizing treatment with your whitening.
• You may experience temporary gum irritation, which is more prevalent in clients that have brush abrasion from brushing teeth within 4 hours prior to whitening.

Recommendations: To maintain healthy teeth and gums, it is recommended that you visit your dentist on a regular basis. If you have allergies or reactions to peroxide or glycerin, teeth whitening is not recommended. If you have diabetes, heart conditions, are pregnant, and/or currently breast feeding you may want to consult with your doctor prior to using whitening products. Ask your representative for a list of ingredients if you have concerns. Any existing mouth sores may feel temporary irritation during and/or after whitening.