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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. 

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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.

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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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