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Boost Energy Patch
  • Boost Energy Patch
  • Boost Energy Patch
  • Boost Energy Patch
  • Boost Energy Patch
  • Boost Energy Patch
Boost Energy Patch
$30.00

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

Love coffee but hate the jitters that come along with it? We get it. Our Energy/Focus patch contains Yerba Mate, Green Tea Extract, Green Coffee Extract, and more, packed with antioxidants and nutrients. You’ll be able to focus on the task without sacrificing your caffeine fix; you’ll just be wearing it instead!

Each package contains a 28-day supply of Patches.


Ingredients:
 * Caffeine (20mg)
 * Yerba Mate (4mg) to improve focus and boost your immune system 
 * Guarana Extract 22% (4mg) to reduce mental and physical fatigue 
 * Green Tea Extract (3mg) to keep your blood pressure in check 
 * Green Coffee Extract (3mg) for a healthy caffeine kick 
 * Fat Soluble Vitamin Blend (2mg) so your body can easily absorb nutrients 
 * Orange Citrus Fragrance Oil (1mg) because why not smell like citrus and be able to focus simultaneously? 
 * Agmatine Sulfate (2mg)to ease nerve pain and improve athletic performance 
 

Product details

• Made in United States
• Product Language: English
• Weight: 1.12 oz (31.75 g)
• Dimensions: 0 in (0 cm)
• SKU: 00850031081000
• GTIN: 850031081000

Eco-friendly information

Packaging: Recyclable and Recycled

Production: Cruelty-free, Ethically sourced, and Fair trade
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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