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* Special Note: A
dental examination is required prior to bleaching. Some discolorations
may indicate the need for treatment other than bleaching. The trays should
only be used by patients with healthy gum tissue. The product is not intended
for use by pregnant women. Gum tissue irritation may result for individuals
with periodontal disease.
Because bleaching or whitening your teeth can pose a health
risk to some individuals, Dr. Aschacher reserves the right to refuse treatment
to any patient that he deems should not partisipate in this proceedure.
In the event that a patient is denied bleaching by Dr. Aschacher, no other
discounted treatment will be offered in it's place.
Results may vary.
In approximately 5% of the population, teeth may be resistant to bleaching.
Bleaching teeth with large metal fillings may cause the metal color to
show through the teeth.
Acidic foods or juices may cause sensitivity if consumed shortly after
bleaching. The patient should not use tobacco products or eat while bleaching.
The gel should be kept out of heat or sunlight and should not be allowed
to freeze.
Some patients may experience sensitivity, which, is most often mild and
transient. In some cases, the patient may require treatment from the clinician.
Patients who experience significant discomfort should stop using the product
and consult the clinician.
THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR
PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED
FOR PAYMENT FOR ANY OTHER SERVICE EXAMINATION, OR TREATMENT THAT IS PERFORMED
AS A RESULT OF AN WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR
THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE EXAMINATION, OR TREATMENT.
ADA CODE: D9972-External Bleaching and D0150-Dental Exam
Dr. Paul C. Aschacher Lic.# DN10702
** This fee is reflective of the minimum fee only.
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