Firstly, I just want to say thank you for choosing to book an appointment with me! It means a lot, truly. When booking appointments, I want you to acknowledge and keep in mind that I am not a dentist (yet) so I do not hold responsibility for anything that happens to your teeth due to poor hygiene or any other medical conditions after my services. What I do is simply make your teeth look shiny by using natural Swarovski crystals (which are lead and metal-free, so don’t worry if you swallow any of them) and real gold gems. Please read the agreement form below as well.

**Acknowledgment and Waiver:** I, **[Client's Full Name]**, hereby acknowledge and agree to the following terms and conditions related to the application of tooth gems:

1. **No Liability for Loss or Damage:** - I understand and agree that BlackSwanGems are not liable if the tooth gem falls off, is swallowed, or if any adverse effects occur to my teeth as a result of the tooth gem application and poor oral hygiene or any other circumstances.

2. **Responsibility for Oral Care and Maintenance:** - I agree that, following the application of the tooth gem, I am solely responsible for maintaining proper oral hygiene and taking care to preserve the gem's placement. This includes: - **Avoiding excessive brushing:** I will not brush too hard on the area where the tooth gem is applied. - **Avoiding certain foods:** I will refrain from eating crunchy or sticky foods that could dislodge the tooth gem. - **Avoiding strenuous activity:** I will not engage in any activities that may impact my mouth or cause the tooth gem to loosen. - **Avoiding contact with the tooth gem:** I will not touch the tooth gem with my tongue or attempt to pick at it with my fingers or any other objects.

3. **Assumption of Risk:** - I understand that while the tooth gem application process is completely safe, there are inherent risks involved. By signing this waiver, I assume full responsibility for any and all risks, including the possibility of swallowing the gem, or any other adverse effects.

4. **No Guarantees:** - I acknowledge that BlackSwanGems makes no guarantees regarding the longevity of the tooth gem, and I understand that its lifespan can vary based on individual circumstances and oral habits.

**Signature:** I have read, understood, and agree to the terms and conditions stated above. By making an appointment, I release BlackSwanGems from any and all liability related to the application and aftercare of my tooth gem.