Available on

Apple Android Windows

Patient Consent for Whitening Mobile App

This mobile app is a consent form for a whitening procedure. It outlines for the patient in detail the risks, benefits, and alternatives to the whitening procedures. Patients must then sign and date the app. Customize this app to meet your Dental practice's requirements.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Patient Consent for Whitening Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    I understand yellow and brown stains usually lighten better than gray or blue stains.

  • Ico statictext

    I understand that participating in whitening treatments can whiten my teeth, giving me a healthi...

  • Ico statictext

    I understand it is impossible to place a specific time frame on how long the lightened appearance...

  • Ico statictext

    I understand if I do not participate in whitening procedures, my tooth color will remain the sam...

  • Ico signature

    Patient Signature

  • Ico date


  • ...and More!

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