IN-OFFICE
CONSENT FORM

_In consideration of participating in In-office cosmetic dentistry and aesthetics treatment  (the "Activity") including but not limited to Teeth Whitening, Non-Invasive Veneers and Hyaluronic Lip Fillers. As consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge TEETH BY TIANNA, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any injury, 


_Staff of Teeth By Tianna are NOT dentist.  

_Teeth By Tianna own the exclusive rights to display photos and/or videos taken and use of promotion. 

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE TEETH BY TIANNA AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST TEETH BY TIANNA.

By completing this form I agree to terms & conditions.

First Name

Last Name

Email

Phone

DOB

Continue