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Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
  • Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
  • Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
  • Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
  • Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
Coconut Lip Scrub & Lip Balm Kit, Moisturizing Lip Treatment
$24.00

Latisse Patient Consent Form

Thank you! Your medical questionnairehas been submitted successfully.
Please fill out all required fields.

1. Ocular History (Eyes)

Are you currently using any prescription eye drops for Glaucoma or ocular hypertension? (e.g., Lumigan, Xalatan, Timolol)
Have you ever been diagnosed with high eye pressure (Ocular Hypertension) or Glaucoma?
Have you had any eye surgery in the last 6 months (Cataract, LASIK, etc.)?
Do you have a history of eye inflammation (Uveitis or Iritis)?
Do you have any active eye infections or chronic "dry eye" symptoms?
Do you wear contact lenses? (Note: Lenses must be removed before application)

2. Medical History

Do you have any known allergies to Bimatoprost or other prostaglandins?
Are you currently pregnant, planning to become pregnant, or breastfeeding?
Do you have a history of skin sensitivity or eczema on your eyelids?

3. Informed Consent & Risks

Please initial next to each point to acknowledge you understand the potential side effects:

Permanent Pigmentation: I understand that Latisse may cause increased brown pigmentation of the colored part of the eye (the iris), which is likely permanent.
Skin Darkening: I understand that darkening of the eyelid skin may occur but is typically reversible if the product is discontinued.
Hair Growth: I understand that hair growth can occur in any skin area that Latisse frequently touches; I will blot any excess solution.
Common Irritation: I understand that eye redness, itchiness, and dryness are common side effects.

Patient Attestation

I certify that the information provided above is true and accurate to the best of my knowledge. I have been informed of the potential side effects and the proper application technique.

Details

Say goodbye to chapped and dry lips with our Coconut Lip Scrub and Balm Kit. Our formula with Organic Coconut Oil has nourishing and moisturizing properties, making your lips soft and velvety smooth. Additionally, our lip balm also works as a moisturizing lip mask when a thick layer is left on overnight!

Our kit is made with 100% natural ingredients and vegan + cruelty-free, so you can feel safe and good about what you're putting on your lips. 

Our Coconut Lip Scrub and Balm Kit comes in sustainable packaging made with 98% recycled materials (PCR), so you can care for your lips and the environment at the same time.

HOW TO USE:
1. Start by gently exfoliating your lips with a small amount of scrub.

2. Apply a light layer of balm on your lips for a soft nourishing effect or put a thicker layer and leave it on overnight for an intense mask effect.

Holiday tip: Perfect size and price for gift or stocking stuffer this Christmas Season!

Product details

• Made in Italy
• Ingredients: LIP SCRUB:
RICINUS COMMUNIS SEED OIL (RICINUS COMMUNIS (CASTOR) SEED OIL)**, HELIANTHUS ANNUUS SEED OIL (HELIANTHUS ANNUUS (SUNFLOWER) SEED OIL)**, COPERNICIA CERIFERA CERA (COPERNICIA CERIFERA (CARNAUBA) WAX)**, ORYZA SATIVA POWDER (ORYZA SATIVA (RICE) POWDER)**, C10-18 TRIGLYCERIDES*, ISOAMYL LAURATE*, TRIBEHENIN*, JOJOBA ESTERS*, BUTYROSPERMUM PARKII BUTTER (BUTYROSPERMUM PARKII (SHEA) BUTTER)**, HELIANTHUS ANNUUS (SUNFLOWER) SEED WAX*, COCOS NUCIFERA OIL (COCOS NUCIFERA (COCONUT) OIL)**, CANDELILLA CERA (EUPHORBIA CERIFERA (CANDELILLA) WAX)*, PARFUM (FRAGRANCE)*, POLYGLYCERIN-3*, ACACIA DECURRENS FLOWER WAX*, LECITHIN*, CI 77891 (TITANIUM DIOXIDE)*, TOCOPHEROL*, ASCORBYL PALMITATE*, CITRIC ACID*

LIP BALM:
RICINUS COMMUNIS SEED OIL (RICINUS COMMUNIS (CASTOR) SEED OIL)**, HELIANTHUS ANNUUS SEED OIL (HELIANTHUS ANNUUS (SUNFLOWER) SEED OIL)**, COPERNICIA CERIFERA CERA (COPERNICIA CERIFERA (CARNAUBA) WAX)**, C10-18 TRIGLYCERIDES*, ISOAMYL LAURATE*, TRIBEHENIN*, JOJOBA ESTERS*, BUTYROSPERMUM PARKII BUTTER (BUTYROSPERMUM PARKII (SHEA) BUTTER)**, HELIANTHUS ANNUUS (SUNFLOWER) SEED WAX*, COCOS NUCIFERA OIL (COCOS NUCIFERA (COCONUT) OIL)**, CANDELILLA CERA (EUPHORBIA CERIFERA (CANDELILLA) WAX)*, PARFUM (FRAGRANCE)*, POLYGLYCERIN-3*, ACACIA DECURRENS FLOWER WAX*, LECITHIN*, CI 77891 (TITANIUM DIOXIDE)*, TOCOPHEROL*, ASCORBYL PALMITATE*, CITRIC ACID*

*natural ingredient
**natural organic ingredient
• Product Language: Dutch, English, French, Italian, and Spanish

Eco-friendly information

Product Materials: Organic and Vegan

Packaging: Recycled

Production: Cruelty-free
Materials + Care

We prioritize quality in selecting the materials for our items, choosing premium fabrics and finishings that ensure durability, comfort, and timeless appeal.
Shipping + Returns

We strive to process and ship all orders in a timely manner, working diligently to ensure that your items are on their way to you as soon as possible.

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