Forever White Program
A great Program for YOU!
We feel every patient in our practice deserves to have a smile that they can be proud of. We are excited to offer our patients a unique program called Forever White.
When you come to our office for your check up, x-rays and cleaning, we will provide you with custom bleaching trays and a tube of whitening gel. Then, at each recommended check up, we will give you another complementary tube of whitening gel. This ensures that you will be able to keep your teeth bright and beautiful.
The details of the Forever White program are listed below. Please review the policy and sign below acknowledging you understand the requirements for eligibility.
- Be a patient of record and at least 18 years old.
- Have had a complete examination by one of our doctors in our office, with recommended x-rays and cleaning or periodontal maintenance.
- No active untreated gum disease, decay, root sensitivity, oral cancer, etc.
- Must keep recommended schedule for check up, x-rays and cleaning/periodontal maintenance.
- A 48 hour notice must be given in the event that you need to change your appointment.
- The appointment may not be rescheduled more than one time.
- The appointment must be completed within 2 weeks of the recommended check up date.
- No Shows disqualify you for that check up period.
(If participant becomes disqualified for that checkup appointment because of scheduling reasons, gel may be purchased individually.)
Trays and Gel
- A maximum of one whitening solution will be rewarded at each check up/cleaning appointment but not more than twice annually.
- Lost or destroyed trays will be replaced at participant’s cost.
- Account must be paid in full to qualify for the Forever White program.
- We reserve the right to change whitening product type at any time.
- We reserve the right to discontinue your enrollment of the Forever White program at any time if deemed necessary for any reason.
- Failure to follow any of the above patient responsibilities will result in termination of the Forever White program.
- Must agree to, read and sign the whitening consent form.