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Teeth Whitening Suitability & Dental History Form
A whitening suitability template — screens dental work, sensitivity and health to set honest expectations and treat safely.
Description
Form fields
Everything the Teeth Whitening Suitability & Dental History Form above collects — 7 fields, so you can see exactly what it captures before you make it your own.
Whitening Suitability & Dental History
Your name
Name
Email address
Date of birth
Please tick anything that applies
Multi-Select
Have you seen a dentist recently, and are your teeth and gums healthy?
Yes/No
Please give any details we should know
Long Answer
Accuracy
Consent
No credit card-
Unlimited forms
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Unlimited results
Template FAQs
Common questions about the Teeth Whitening Suitability & Dental History Form — what it captures, when to use it, and how to make it your own.
Why screen dental history before whitening?
Because whitening only works on natural teeth and some conditions mean it should wait. Screening for dental work, sensitivity and gum health lets you treat safely and set honest expectations about the result.
Will crowns, veneers and fillings whiten?
No — whitening doesn’t change the colour of existing dental work, and it can end up mismatched against newly-whitened natural teeth. The form flags these so clients understand before treatment, not after.
Why does gum health matter?
Because whitening gel on inflamed or diseased gums can irritate them, and underlying problems should be treated first. Confirming the client has healthy gums and sees a dentist keeps treatment safe.
Should sensitive teeth stop someone whitening?
Not necessarily — but it means adapting the approach and using gentler products. Knowing in advance lets you manage sensitivity rather than being caught out by it during treatment.
Why ask about pregnancy?
Because whitening is generally avoided during pregnancy and breastfeeding as a precaution. The form captures it so you can advise the client to wait if that applies.
Is the form free?
Yes. It’s free with a Fun Forms account, fully brandable, and ready to complete on a tablet or via a link before treatment.
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No credit card
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Unlimited forms
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Unlimited results
