• LatisseTM Consent Form

  • LatisseTM is FDA approved for the treatment of the eyelashes by making them grow longer, thicker, and darker. The onset of action is gradual with most users seeing significant improvement in the length and number of lashes by 2 months.

    If LatisseTM is discontinued the eyelashes and eyelids will return to their previous appearance over several weeks to months.

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  • Risks and Possible Side Effects of Using LatisseTM

    Please review and select each bullet below to indicate that you understand the risks and possible side effects of using LatisseTM, have been given the opportunity to speak with a healthcare provider about this in more detail and have any questions answered.
  • Contraindications of using LatisseTM

    You should not use LatisseTM if any of the following apply to you:
    • You are allergic or hypersensitive to bimatoprost (Lumigan) or any other ingredients in this product
    • You are about to undergo cataract or other eye procedures
    • You have intraocular inflammation (uveitis)
    • You have risk factors for macular edema
    • You have an eye infection
    • You are being treated for glaucoma with eye drops, unless cleared by your treating opthalmologist 
    • You are under the age of 18
    • You are pregnant or lactating 
  • Patient's Acceptance of Risks

    Please read and select each of the following options to indicate that you have read, understand, and have been given the opportunity to discuss this product and its intended treatment with a healthcare professional in order to answer any questions you may have.
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