I understand that the gem and bonding agents may cause an allergic reaction when placed or swallowed, causing redness and swelling of the tissue, pain, itching, vomiting or severe allergic reactions.

I understand that the gem may contain some less as in all glass/crystal/metallics.

I understand that during placement it may be necessary to change or add procedures because of conditions found while working on the teeth that were not discovered during inspection.

I understand that this procedure is temporary

I understand that the gem is bonded to the enamel.

I understand that if I want to remove the gem I will have to go to a dentist or dental professional and I am responsible for all costs associated with removal/cleaning

I understand that if I whiten my teeth or stain my teeth while wearing the tooth gem that the area beneath the gem will be a different colour and I accept all costs associated with corrections

I understand that if the gem(s) fall off that I am solely responsible for the cost of replacing them or removing any adhesive that may be remaining

I agree that the tooth/teeth I am getting the gems placed on is a real and flat tooth/ teeth - If you have a tooth that is a false, crowned, or capped the Tooth Jewel glue will not adhere to the false tooth.

I authorize Glitter Gaud to apply a Tooth Jewel with Dental Adhesive to my tooth/ teeth and that this/these teeth are real.

I understand that this procedure is temporary and on average a gem lasts four months

I acknowledge that by signing this agreement that I have been given full opportunity to ask any & all questions I might have about obtaining a tooth gem the process and that all of my questions have been answered to my full satisfaction.

I am over the age of 12 years old

I am not under the influence of ANY drugs or alcohol.My artist has advised me on location and expected results and I understand that variations may exist.

I do not have any mental, physical or medical impairment or disability which may affect my well being as a direct or indirect result of my decision to get this procedure

I have truthfully represented to my artist that the obtaining of a tooth gem(s) is/are by my choice alone.

I consent to the application of the gem(s) and to any actions or conduct of the representatives and employees of the studio that are reasonably necessary to perform the procedure.

I consent to ALL terms laid out in Glitter Gaud's Policy and that if I have misrepresented ANY term in this agreement that I, alone accept full responsibility of any and all consequences of my actions.

I agree to release & forever discharge & hold harmless Glitter Gaud & all independent contractors or employees from any claims, damages or legal actions arising from or connected in any way to my procedure or the procedure and conduct used.