Tooth Gem consent form

Thanks for booking your tooth gem procedure at Teddington Ink.

Please complete this consent form on the day of your appointment. It helps us provide a safe and professional experience.

🔞 Age-Based Tooth Gem Guidelines


  • Under 16: We do not apply tooth gems.
  • 16–17 years: Tooth gems can be applied to adult teeth only. Parent/legal guardian must attend in person and co-sign the consent form.
  • 18+ years: Eligible for all tooth gem services.



🪪 ID & Guardian Documentation


  • Clients under 25 must show original photo ID.
  • Clients aged 16–17 must bring:
  • • Photo ID for both client and guardian, and
  • • Either ID with the same surname as guardian, or
  • • Additional documentation confirming legal guardianship (e.g. birth certificate).
  • No photocopies or digital images accepted.
  • Appointments cannot proceed without valid ID and a completed form.


⚠️ Medical & Dental Considerations

Tooth gems cannot be applied if you:


  • Have gum disease, untreated cavities, or recent dental work (within 6 months).
  • Have veneers, crowns, caps, or braces on the tooth.
  • Are currently pregnant, breastfeeding, or under the influence of drugs/alcohol.


If any answers indicate medical or dental concerns, we may request a dentist’s note to confirm it is safe to proceed. Your safety is our top priority.


✍️ Consent Acknowledgements

By signing this form, you agree that:


  • You understand the tooth gem procedure and aftercare requirements.
  • You are aware of possible risks, including enamel sensitivity, irritation, or premature gem loss.
  • You understand that removal must only be carried out by a qualified dentist.
  • You have disclosed all relevant medical and dental information.
  • You are over 16 (or accompanied by a parent/guardian if under 18).
  • You accept possible communication from us — unsubscribe at any time.



📋 Fill Out the Form Below to Proceed