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  • UpneeqTM Consent Form

  • UpneeqTM (oxymetazoline hydrochloride ophthalmic solution) is an FDA-approved prescription for acquired ptosis (low-lying lids)

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  • Risks and Possible Side Effects of Using UpneeqTM

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

    You should not use UpneeqTM if any of the following apply to you:
    • Uncontrolled/untreated glaucoma
    • May cause increased eye pressure
  • 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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      UpneeqUPNEEQ (oxymetazoline hydrochloride ophthalmic solution) - the only FDA-approved treatment for acquired ptosis (low-lying lids)
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