Teeth Whitening Consultation Form

Professional Teeth Whitening Consultation Made Simple

Getting a brighter, more confident smile starts with understanding your unique needs. This teeth whitening consultation form helps dental practices gather essential information about patients' current tooth shade, sensitivity concerns, lifestyle factors, and aesthetic goals—all before the first appointment.

Whether you run a cosmetic dentistry practice, general dental office, or aesthetic clinic offering whitening services, this template streamlines your consultation process while ensuring you capture everything needed to recommend the right treatment plan.

What This Template Helps You Capture

This form walks patients through a complete pre-treatment assessment, including:

• Current shade assessment using the VITA shade guide to establish baseline expectations
• Sensitivity screening to identify potential concerns and adjust treatment accordingly
• Dental history including previous whitening experiences and existing dental work
• Lifestyle factors like coffee, tea, wine consumption and smoking habits that affect results
• Treatment preferences between in-office, take-home, or combination approaches
• Maintenance plan options to help patients maintain their results long-term
• Budget and timeline expectations to match the right service to each patient

Why Paperform for Dental Consultations

Dental practices love Paperform because it brings a professional, on-brand experience to every patient interaction. The form feels modern and approachable—not like a clinical questionnaire—which helps increase completion rates and sets the right tone for cosmetic services.

With conditional logic built in, you can show different questions based on previous answers (like asking about sensitivity history only if they indicate concerns), keeping the form relevant and efficient. Add your practice logo, use your brand colors, and embed the form directly on your website so patients never feel like they're leaving your care.

The calculation features can even help you provide instant treatment estimates or show different service packages based on their selections, turning a simple intake into a conversion-focused experience.

Beyond the Form: Automate Your Whitening Workflow

Once a patient submits their consultation, Stepper can automatically:

• Add the patient to your dental practice management software
• Send a confirmation email with pre-treatment instructions
• Create a calendar appointment for their consultation or treatment
• Notify your front desk team to follow up with scheduling
• Trigger a reminder sequence leading up to their appointment

This means your team spends less time on manual data entry and more time providing exceptional patient care.

For practices that need consent forms signed before treatment, Papersign lets you automatically generate and send whitening treatment consent documents for eSignature, keeping everything linked to the original consultation for complete audit trails.

Built for Dental Practices That Value Patient Experience

This template is perfect for cosmetic dentists, general dental practices offering whitening services, dental spas, and aesthetic clinics. It's designed to feel warm and inviting while gathering clinical detail—the perfect balance for elective cosmetic treatments where patient comfort and confidence drive conversions.

Trusted by dental practices worldwide, Paperform is SOC 2 Type II & GDPR compliant, ensuring patient information stays secure and your practice stays compliant with healthcare data standards.