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Hello & Thank you for choosing shine by kellie for your professional teeth whitening needs!

Please fill out all 3 forms below 48 hours  prior to your appointment time. 

All forms must be submitted online BEFORE your scheduled appointment. 

IF THIS IS NOT COMPLETED 24 HOURS PRIOR TO YOUR APPOINTMENT IT MAY RESULT IN CANCELLATIONS OR DELAYS IN YOUR APPOINTMENT.

THANK YOU FOR YOUR CO-OPERATION.

Please see FAQ for any questions you may have.

Be sure to check out the Before and After Care.

Burlington, ON

Medical + Dental History 

Please fill out the medical + dental history upon booking your appointment. 

Do you smoke?
Do you have sensitive teeth?
How often do you drink coffee/tea?
Do you have veneers, crowns, anterior bonding, bridges or dentures in your visible smile?
Do you have any white or brown spots on your teeth?
Upload File

Thanks for submitting!

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