About this template
A Tooth Gem Consent Form is an essential document for beauty professionals, cosmetic technicians, and dental practitioners who apply semi-permanent tooth jewelry. This template ensures that clients understand the risks, application process, and vital aftercare instructions before undergoing the procedure. By clearly outlining what to expect and gathering necessary health details, you safeguard your business while building trust with your clientele.
With Doc2Form, you can instantly turn this document into a ready-to-use Google Form, making it simple to send to clients via email or text before their appointment. The form efficiently collects contact information, relevant dental history, liability acknowledgments, and digital sign-offs in one secure location. Streamline your intake process, reduce paperwork, and maintain organized records of all client agreements directly within your Google Workspace.
Key features
- Collect client contact details and medical histories seamlessly.
- Ensure clients review and accept procedural risks and terms.
- Include clear aftercare instructions for longevity and safety.
- Gather digital acknowledgments and signatures quickly.
- Store and organize all client responses securely in Google Drive.
Use cases
- Tooth gem and grillz application appointments
- Cosmetic dental procedure waiver collection
- Pop-up beauty shop and salon client intake
- Mobile tooth-tech service pre-appointment screening
What this form collects
- Full Name (Short answer)Enter your first and last name as it appears on your government-issued ID.
- Date of Birth (Date)Enter your date of birth (MM/DD/YYYY).
- Phone Number (Short answer)Provide the best phone number to reach you regarding your appointment.
- Email Address (Short answer)Where should we send your appointment confirmation and aftercare guide?
- Home Address (Paragraph)Enter your current residential address.
- Medical History & Dental Health (Paragraph)Do you have any history of gum disease, tooth sensitivity, enamel hypoplasia, or known allergies to dental adhesives or metals? Please describe below.
- Are you currently pregnant or nursing? (Multiple choice)Certain cosmetic procedures require extra precautions.
- Terms and Conditions Acceptance (Multiple choice)I understand that tooth gems are semi-permanent cosmetic accessories. I confirm that I am at least 18 years of age (or have guardian consent), have disclosed all relevant dental history, and agree to follow all post-application aftercare instructions.
- Client Signature (Short answer)Please type your full legal name here to serve as your digital signature.
- Signing Date (Date)Select today's date.
FAQ
What is a tooth gem consent form?
It is a legal and informational document that outlines the details of a tooth gem application, details potential risks, and records the client's agreement to proceed.
Why do I need a consent form for tooth gems?
It protects both the technician and the client by confirming that the client has been fully informed about the procedure, adhesive safety, and proper aftercare.
What medical information should be included?
The form should screen for conditions such as tooth sensitivity, gum disease, allergies to dental adhesives, or recent dental work that might affect the procedure.
Can I customize this Google Form template?
Yes! Once generated via Doc2Form, you can fully edit questions, add your business branding, and adjust aftercare instructions directly in Google Forms.
How do clients sign the form?
Clients can fill out the form and submit their agreement on any device, providing acknowledgment of the terms before sitting in the chair.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.