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Home Whitening Kit Order Form
A home whitening kit template — clients order a kit or refill gel, choose strength and confirm suitability and delivery.
Description
Form fields
Everything the Home Whitening Kit Order Form above collects — 10 fields, so you can see exactly what it captures before you make it your own.
Home Whitening Kit Order
Your name
Name
Email address
Phone number
Telephone
Which kit would you like?
Dropdown
Strength
DropdownHave you had custom whitening trays fitted?
Yes/No
Delivery address
Short Answer
Are you over 18 and have you read the suitability guidance?
Yes/NoAnything we should know?
Long Answer
I'm happy to be contacted about my treatment
Consent
No credit card-
Unlimited forms
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Unlimited results
Template FAQs
Common questions about the Home Whitening Kit Order Form — what it captures, when to use it, and how to make it your own.
What kits can clients order?
Starter, standard and pro kits, refill gel on its own, and custom-tray kits — with a strength choice including a gentle option for sensitive teeth, so clients can order exactly what suits them.
Why ask if they've had custom trays fitted?
Because it changes what to supply — a client with fitted trays usually just needs refill gel, while others need a full kit or an impression. Knowing avoids sending the wrong thing.
Why confirm the client is over 18 and has read the guidance?
Because home whitening should be used responsibly. A required confirmation keeps it appropriate and ensures you’re supplying gel to clients who understand how to use it safely.
Can clients reorder just the gel?
Yes — refill gel is one of the options, so returning clients with trays can quickly top up without buying a whole new kit.
How do orders reach me?
They land in your Fun Forms inbox and can email you automatically, with the delivery address and kit choice ready to fulfil.
Is the form free?
Yes. It’s free with a Fun Forms account, fully brandable, and ready to embed or share as a link.
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No credit card
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Unlimited forms
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Unlimited results
