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New Patient Form.
- Luminous Smiles by Lucy
- Welcome to Luminous Smiles by Lucy!
We appreciate the fact that you have considered us for you choice of teeth whitening service. Here at Luminous Smiles by Lucy we are dedicated to your smile. Clearly you are too.
This is a one hour service. Once the kit is purchased. (On-site)..Application is the next step. The light used is a LED light. The gel is peroxide based. 16% peroxide which is the highest level even used by dentist. Session is broken into two 30 minute sittings, In one appointment.
This is a cosmetic teeth whitening. In no form today’s application should be considered as a substitute for dental work. No teeth cleaning/picking/etc is involved. Teeth whitening gives you a noticeable lift. 2-10 shades. Your teeth can only lift as white as your natural DNA allows. Some clients have done more than one application. If you would like a second lift. I suggest 30 days in between. Follow up lift. Every client differs. Clients have been completely happy with one lift. Then you have clients who want that extra boost!
Luminous Smiles by Lucy is a very clean environment. The chairs are cleaned between every visit. If you would like the chairs wiped in your presence alert staff. Your safety and ours are top priority. Entire kits are disposed of after each application. Suite will be wiped down every 3 hours. Staff wears gloves. Staff wears smiles.
Children are allowed under parental vision. Children are encouraged to sit in seats. (Unless play area available). Luminous Smiles by Lucy does NOT have a public restroom. Luminous Smiles by Lucy is NOT responsible for your children’s accidents outside of designated seating area.
Here at Luminous Smiles by Lucy we take pride in our work. We do take BEFORE/AFTER pictures for our files. We also use BEFORE/AFTER pictures as a form of advertisement. This is optional to each client. If you choose to opt out on pictures we respect your wishes.
AFTERCARE: •••••••••••••••••••••••••
•DO NOT SMOKE (HIGHLY ADVISE MINIMUM OF ONE HOUR AND THIRTY MINUTES BEFORE SMOKING. ) (1 1/2 HOURS).
•NO DARK OR FRIED FOODS , DARK, COLORED CHIPS, HOT CHIPS, DARK CANDY, SPAGHETTI, CHILLI, BEETS, CARROTS. ANY DYED FOODS. (24 HOURS)
•NO RED DRINKS (24 HOURS)
•NO DARK DRINKS: SODA,COFFEE,WINE,HOT CHOCOLATE,(24 HOURS)
THE PORES IN YOUR TEETH WILL STILL BE OPEN UP TO 24 HOURS AFTER APPLICATION. TRY TO KEEP THAT IN MIND BEFORE INDULGING. DRINKING THROUGH STRAW IS SUGGESTED THE FIRST 12 HOURS AS WELL.
YOU CAN RESUME REGULAR BRUSHING THE SAME NIGHT. (CHARCOAL TOOTHPASTE DEFINITELY NOT RECOMMENDED THE SAME NIGHT!!! SUGGESTED (24 HOURS) BEFORE USE OF CHARCOAL ANY CHARCOAL BASED PRODUCTS AS THE PORES OF YOUR TEETH ARE STILL OPEN.
I HAVE READ AND FULLY UNDERSTAND AND AGREE WITH THE TEETH WHITENING KIT PURCHASE AND APPLICATION SERVICE PROVIDED TODAY. I HAVE READ AND UNDERSTAND THE AFTER CARE INSTRUCTIONS PROVIDED BY LUMINOUS SMILES BY LUCY. ••••••••••••••••••••••••••••••••••••••••WE RESPECT YOUR WISHES!
PHOTOGRAPH CONSENT/REFUSAL
I GIVE CONSENT FOR MY PICTURES TO BE TAKEN FOR USE OF ADVERTISEMENT AS FAR AS (PLEASE CIRCLE ANSWER) THESE ARE BEFORE/AFTER PICTURES.
•WEBSITE PICTURES
•PORTFOLIO PICTURES (VIEWED BY CUSTOMERS)
•PRIVATE PORTFOLIO PICTURES (VIEWED BY THE CLIENT (YOU) AND LUMINOUS SMILES BY LUCY STAFF ONLY) NOT TO BE SHOWCASED IN ANY FORM.
•IN SHOP PICTURES (WALL/FRAME) ••••••••••••••••••••••••••••••••••••••••I DO NOT GIVE MY CONSENT TO TAKE OR ADVERTISE PICTURES IN ANY FORM OR FOR NO REASON•••••••••••••••••••••••••••••••••••••••••
THANKYOU FOR YOUR BUSINESS
LUMINOUS SMILES BY LUCY
Files coming soon.
Peroxide based teeth application. One hour led lighting
Session is broken up into two thirty minute sessions ran within the hour.
Opening soon!!!
Will be opening soon! Will be doing $67 specials until January 1st.
They just smile when I ask “Do you feel Luminous?”
So far so good. Ive been told “I smile for no reason now.“
December special
$67 the ENTIRE MONTH OF DECEMBER
Big news
1316 Harrison
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