Please fill out the LATISSE MEDICAL HISTORY & CONSENT FORM (you can download the form by clicking on the link "CLICK HERE FOR DOWNLOAD" in the brief description of this product) and either fax to 267-392-3269 or Email to docrn7@yahoo.com. PLEASE CONTACT OUR OFFICE BEFORE YOU ORDER AT 540-774-5505 TO SPEAK WITH OUR NURSE! You may purchase Latisse prior to filling out and faxing or emailing this form, however Latisse will not be shipped out to you until we have received this completed form and have talked to our nurse.. We apologize for the inconvenience, however this is required by Allergan. If you have already filled out this form before you do not need to fill it out again, please proceed with your purchase. Once we receive the completed form, Dr. Hess will review and approve your purchase. There is no charge for this service. We will ship out your order the same day. This will serve as valid History and Consent form to purchases Latisse from The Skin Spa only and is not a prescription to purchase Latisse anywhere else. Once you have completed and signed the Medical History and Consent Form, Dr. Hess will review and approve/disapprove and sign the order. This will serve as your prescription and will be kept in our records for repeat orders. As this is a prescription product, "THERE ARE NO REFUNDS ONCE YOU HAVE COMPLETED YOUR ORDER". Please review the contraindications and possible side effects of Latisse before purchasing. You may contact The Skin Spa at 540-774-5505 or docrn7@yahoo.com and we will be glad to answer any questions you may have or make an appointment to see Dr. Hess.THIS FORM IS A WORD DOCUMENT
COMMONLY ASKED QUESTIONS ABOUT LATISSE
Q: What exactly does Latisse do?
A: It treats hypotrichosis (another name for inadequate eyelashes) by enhancing eyelash prominence as measured by increases in the length, thickness, and darkness of the eyelashes, and is approved by the FDA.
Q: How long can I use Latisse?
A: According to Allergan, the makers of Latisse, (see their newly launched website for more information, www.latisse.com) each prescription lasts 30 days, and there is no recommended stop time. The “peak effect” comes at roughly four months of use. Speak to your prescribing doctor about the length of treatment that’s right for you.
Q: Will my lashes stay longer forever?
A: After you stop using Latisse they will slowly go back to normal with your next eyelash growth cycle (this varies from person to person but is between a few weeks to a couple months).
Q: How long before I start to see results?
A: Eight weeks, with peak results around four months.
Q: Can I use Latisse if I’ve had Lasik or wear contacts?
A: These are questions for your doctor. You should not use Latisse if you have an active eye condition, including an eye infection, or have broken or irritated skin on your eyelid. And if you are using products for elevated intraocular pressure, be sure to discuss this with your doctor. Contact lenses should be removed prior to use of Latisee and may be reinserted 15 minutes following its application.
For other possible side effects, go to www.latisse.com and speak with your doctor.
***Note: This is a 30 day (4weeks) supply of this treatment (one box of .3ml solution and 60applicator brushes) one applicator brush for each eye applied one time per day for 30 days in the evening. Full results at 16 weeks. Get ready for a new innovation in lashes. LATISSE™ (bimatoprost ophthalmic solution) 0.03% is the first and only prescription treatment approved by the FDA for inadequate or insufficient eyelashes, growing them longer, fuller and darker. LATISSE™ works effectively. LATISSE™ makes lash growth possible because of its active ingredient: bimatoprost. Although the precise mechanism of action is not known, research suggests that the growth of eyelashes occurs by increasing the percent of hairs in, and the duration of, the anagen (or growth) phase. Lashes can grow longer, thicker and darker because bimatoprost can also prolong this growth phase. Clinically proven results you can see over time. LATISSE™ is easy to use, FDA approved and effective. It's a once-a-day treatment you apply topically to the base of your upper eyelashes. Patients in a clinical trial saw results gradually over time (starting at 4 weeks with full results after 16 weeks). It's an innovation backed by research. While LATISSE™ is a new treatment in eyelash growth, it was developed through years of research by Allergan, a pharmaceutical leader with over 60 years of expertise in prescription eye care products. How to Apply Like every routine, applying LATISSE™ (bimatoprost ophthalmic solution) 0.03% is all about consistency and precision. Once you follow the basic guidelines, the results will come gradually over time. To see the full effect of your eyelash transformation, take a "before" picture before you start the treatment, and keep taking pictures every 4 weeks to chart your progress. Great eyelashes don't just happen overnight. That's why it's important to note that LATISSE™ (bimatoprost ophthalmic solution) 0.03% works gradually and remarkably — starting at 4 weeks with full results after 16 weeks. Once you begin treatment, you could start to see results in as little as 4 weeks, but you must continue applying the topical treatment each night and follow the directions for best results. Remember results are gradual over time. Your eyelashes will experience real measurable growth. LATISSE™ works from the inside out. As the treatment progresses, you'll begin to see changes in length, thickness and darkness gradually. After week 16, you'll see the full effect of LATISSE™ — and so will others. There are possible side effects. Throughout clinical trials, some users did experience itchy eyes and eye redness. However, some users found that these irritations went away once they became accustomed to the product or began applying it properly. As with any prescription treatment, always consult with your doctor for information and proper usage of LATISSE™ solution Directions for nightly use: Before applying LATISSE™ each night, ensure your face is clean, makeup and contact lenses are removed, and any other facial care products have already been applied. Remove an applicator from its tray. Then, holding the sterile applicator horizontally, place one drop of LATISSE™ solution on the area of the applicator closest to the tip but not on the tip. Immediately draw the applicator carefully along the skin at the base of the upper eyelashes (where the eyelashes meet the skin) just as you would apply liquid eyeliner. This area should feel lightly moist without runoff. Blot any excess solution beyond the eyelid with a tissue. Dispose of the applicator after one use. Repeat for opposite eyelid, using a new sterile applicator to help minimize a
ny
potential for contamination from one eyelid to another.
AVAILABLE COUPONS: BUY 2 LATISSE & GET $25 OFF TOTAL (COUPON CODE: LATISSE2) BUY 4 LATISSE & GET $50 OFF TOTAL ORDER (COUPON CODE: LATISSE5) COUPONS ARE APPLIED DURING THE CHECKOUT PROCESS. IF YOU HAVE ANY QUESTIONS CALL 540-774-5505 OR 540-798-6494
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