Fresh Smiles Consent Form

Fresh Smiles Consent Form

You can use this form to ask for consent about undergoing a teeth whitening procedure. Form Preview
  • How Did You Learn About Our Office?

  • Contact Information

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  • Photo Consent Form

  • I grant permission to Fresh Smiles for the use of my photograph(s), or electronic media images, in any presentation of any kind and social media outlets. I understand that I may revoke this authorization at any time by notifying Fresh Smiles in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.

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  • Informed Customer Consent Form

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