Free Professional Teeth Whitening for Life
is a courtesy and privilege complements of Rittenhouse Smiles. This program is extended to patients who prove themselves as individuals to take their oral hygiene and general dental health seriously. We believe it is extremely important to maintain recommended hygiene care appointments and receive necessary dental treatment to maintain a healthy and beautiful smile. Consequently, we developed this program to reward patients who do so. Patients enrolled in this program will receive complementary professional custom-made take home whitening trays and whitening gel for personal use.

This privilege, while free, does have some rules. Below is a brief description of these rules. Please read through them carefully and sign below, acknowledging that you understand how Free Professional Teeth Whitening for Life works.
Should any of the rules fail to be met, you will immediately be disqualified from the program and provided the opportunity to re-enroll for a $30 reactivation fee.

Patient Activation Rules:

  1. Must be at least 18 years old or have parental consent.
  2. Must complete initial hygiene cleaning, necessary x-rays, doctor’s exam, and an additional hygiene appointment for six months.
  3. Must comply with required dental care as stated by doctor.
  4. Must make all scheduled appointments. Cancellations must be made with a minimum of 48 hours notice and the appointment be rescheduled within the next two weeks and must be completed.
  5. Must not have any outstanding bills with Rittenhouse Smiles

The above rules pertain to new patients and existing patients. Upon meeting these requirements, patients will receive complementary upper and lower whitening trays along with professional whitening gel (1 syringe will be provided per year as recommended by the manufacturer).

Free Whitening for Life Program Form

All patients requesting to be admitted into the Free Whitening for Life Program are required to read, sign and date the program form. Feel free to print and fill out the form before your visit for quicker registration.

Print Free Whitening for Life Program Form

Lifetime Maintenance Rules:

  1. Must maintain continued dental care as stated by doctor and hygienist of Rittenhouse Smiles.
  2. Must maintain continued hygiene care with Rittenhouse Smiles as specified by the doctor and hygienist (6 months cleaning appointments).
  3. Must comply with all Rittenhouse Smiles polices regarding payment and broken appointments.
  4. Lost or destroyed applicator trays will be replaced at a cost to the patient. Applicator trays that no longer fit due to necessary dental work (crowns/bridges) will be replaced at no cost to the patient.